LIBRARY OF CONGRESS. 



T> i *J /) 



UNITED STATES OF AMERICA. 



^ 



THE 



KNOWLEDGE OF THE PHYSICIAN. 



^ Course of lectures 

DELIVERED AT THE BOSTON UNIVERSITY SCHOOL OF 
MEDICINE, MAY, 1884. 



RICHARD HUGHES, M.D. 



/3 



V^ 



'^ WASH! 



BOSTON: 
OTIS CLAPP AND SON. 

1884. 







Copyright, 1884, 
By OTIS CLAPP & SON. 



ELECTROTYPED AND PRINTED 
BY RAND, AVERY, AND COMPANY, 

BOSTON. MASS. 



TO 

I. T. TALBOT, M.D., 

DEAN 

OF THE BOSTON UNIVERSITY SCHOOL OF MEDICINE, 

2ri)is Uolume is IBctiicateU 

BY HIS FRIEND AND SINCERE APPRECIATOR, 
THE AUTHOR. 



CONTENTS. 



LECTURE I. 

THE KNOWLEDGE OF LIFE. 

Introduction. — Medicine an art, ministered to by its associated 
sciences. — All sciences made up of phenomena, laws and 
causes. — The subject of Physiology life. — Life the diffc' 
rentia of the vegetable and animal creation. — Not motion, 
even spontaneous motion. — Not growth and waste. — Life 
consists in assimilation and reproduction. — These essen- 
tially one process, and capable of being pei formed by 
a single substance. — Protoplasm. — Vitality a property 
thereof. — Identical with " Irritability " of Brown. — History 
of discovery. — Fletcher, Beale, Drysdale. — The proto- 
plasmic doctrine of life a better basis for philosophy 
of homoeopathy than that of a "vital force." — Views of 
Hahnemann and Tessier. — Life no entity, but a music 
of which organism is instrument. — Living matter seat of 
disease and drug-action. — Of illimitable sensitiveness, but 
matter still. — We should be dynamists, without being pneu- 
matists 

LECTURE II. 

THE KNOWLEDGE OF HEALTH. 

The physician a hygienist as well as a therapeutist. — Hahne- 
mann and his school exemplify this. — The physician should 
lead the healthy life he inculcates. — Elements of hygiene: 



VI CONTENTS. 

PAGE 

Exercise — Rest — Warmth — Air — Food — Water — Tea 
and Coffee — Tobacco — Alcohol 22 

LECTURE III. 

THE KNOWLEDGE OF DISEASE. 

Semeiology, aetiology, pathology. — First alone certain, and there- 
fore chosen by Hahnemann as disease-basis of his method. 
— Is it sufficient.'' — Not so for nosology, prognosis, diag- 
nosis. — For drug-therapeutics symptomatology surer, more 
thorough, and more effective than pathological inference. — 
Carroll Dunham. — Illustration from Fevers, mflammations, 
neuroses. — Aid given by pathology. — The homoeopathic 
examination of the patient. — Subjective Symptoms. — Dr. 
Russell Reynolds. — Supremacy of Clinical Medicine. — 
Sir Andrew Clark 45 

LECTURE IV. 

THE KNOWLEDGE OF MEDICINES. 

Medicines and Foods. — Modes of discovering medicines- The 
empirical — The rational, from action in health. — Hahne- 
mann. — Symptomatology here also of chief importance. — 
Physiology and pathology also of value. — The zcszis in 
viorbis. — Characteristics. — Drug-action, unlike disease, can 
be studied only in books. — Importance therefore of detailed 
records. — The schema available for reference only, not for 
study. — Text spoilt by it. — Illustration. — Original narra- 
tives must be restored (:^ 

LECTURE V. 

PYREXIA AND THE ANTIPYRETICS. 

Nature of fever. — Heat-production and heat-radiation. — Hyper- 
oxidation main source of febrile heat. — May also occur 
from deficient liberation of heat through skin, and from loss 
of nervous control over whole process (hyperpyrexia). — 
Hectics and intermittents. — Former and present classifica- 
tion of fevers. — Antipyretic treatment as ordinarily prac- 



CONTENTS. Vll 

PAGE 

tised. — The antipyretic remedies of homceopathy. — I. Aco- 
nite ; Gelsemium 91 

LECTURE VI. 

PYREXIA AND THE ANTIPYRETICS {continued). 

II. Belladonna; Hyoscyamus, Stramonium, Agaricus, Veratrum 
viride. — III. Arsenic; Cinchona and Quinine, Lachesis and 
Crotalus. — IV. Bryonia; Rhus, Phosphoric and Muriatic 
Acids, Baptisia 115 

LECTURE VII. 

RHEUMATISM AND THE ANTI-RHEUMATICS. 

Rheumatic fever. — Lactic acid its probable inateries morbi ; 
hence inapplicable in its treatment. — Alkaline treatment. — 
Chronic articular rheumatism. — Muscular rheumatisms. 
— Fibrous rheumatisms. — Anti-rheumatics: I. Bryonia; 
Aconite, Colchicum, Pulsatilla, Propylamine. — Salicylic 
treatment 139 

LECTURE VIII. 

RHEUMATISM AND THE ANTI-RHEUMATICS {continued:). 

II. Rhus: Dulcamara, Rhododendron (Kalmia, Spigelia). — III. 
Cimicifuga; Caulophyllum, Ledum, Ruta, Viola odorata. — 
IV. Mercurius ; Kali bichromicum, Phytolacca. — V. Arsenic ; 
Lactic acid. — VI. Sulphur 162 

LECTURE IX. 

CEREBRAL LOCALISATION AND DRUG ACTION. 

History of assignment of function in nervous system to 1830. — 
Further progress since then. — The cerebellum. — The sen- 
sory and motor paths through cord to brain. — The basal 
ganglia, — The cerebrum the sole seat of consciousness. — 
Does not act as a whole. — Gall and Spurzheim. — The 
cerebral convolutions. — Aphasia. — Localisation of speech- 
centre. — Electrisation of cortex. — Fritsch, Hitzig, Ferrier. 



Vlll CONTENTS. 

PAGE 

— Localisation of sensations and movements. — Process of 
volition. — Ordinarily mechanical. — We have, however, an 
inhibitory control over the process. — Hence moral possi- 
bilities and responsibilities 187 

LECTURE X. 

CEREBRAL LOCALISATION AND DRUG-ACTION {continued). 

Distribution of cerebral arteries. — Confirmatory of localisations 
now established. — Descending paths from "psycho-motor 
area" undeveloped at birth. — Its gray cells larger than 
those of other regions. — Softening of this part only found 
to cause hemiplegia. — " Descending sclerosis." — Its paths. 

— Result of cutting-off from trophic centres. — Its results: 
loss of power and contracture. — "Late rigidity." — Con- 
tracture variable, hence functional only. — Caused by irrita- 
tion of cells of anterior cornua. — Relation of strychnia 
to it. — Can surgery avail itself of cerebral localisation ? — 
Its aspects in clinical medicine. — Dr. Hughlings Jackson. 

— Limited convulsions. "Discharging lesions." — Case. — 
The "aura epileptica." — Carbolic acid in hyperosmia . . 213 

LECTURE XI. 

CEREBRAL LOCALISATION AND DRUG-ACTION {continued). 

Locomotor ataxy. — Its variable elements. — Due to irritation of 
cells of posterior cornua, and possibly remediable, — Agari- 
cus, Arsenic, Belladonna. — Neuralgia. — Aconite, Bella- 
donna. — Migraine. — Ignatia, Nux vomica, Digitalis, Cycla- 
men, Iris. — Epilepsy. — Particular medicines : Aconite ; 
Belladonna; Cannabis indica (Nux moschata) ; Cocculus ; 
Conium (Quinine and Salicylic acid) ; Chamomilla, Coffea, 
lodium, Mercurius ; Santonine. — Importance of criticism 
in using Materia Medica 235 

LECTURE XII. 

THE FUTURE OF PHARMACODYNAMICS. 

Hahnemann's " Examination of the sources of the common 
Materia Medica." — Must be repeated from time to time. — 



CONTENTS. IX 

PAGE 

General principles, — Action of drugs in health to be ascer- 
tained, 1st, on animals; 2d, on man. — Knowledge to be 
gained by observation and experiment. — Poisoning and 
overdosing". — Proving. — Its history and manner, — Hahne- 
mann's provings. — T\\t Fragmeiita de Viribiis. — The A/ate- 
ria Medica Piira. — Its elements; ist, Hahnemann's symp- 
toms — 2d, those of his fellow-provers — 3d, citations from 
authors. -^ The Chronic Diseases. — Hahnemann's contribu- 
tions thereto. — Those of others, — Drs. Sircar and Pope 
in vindication of these pathogeneses. — General character of 
our Materia Medica, — Wheat and chaff. — '* Clinical symp- 
toms" and aggravations. — Wolf and Houat. — Errors of 
translation and copying. — Must be thoroughly sifted, traced 
to originals, and presented (where possible) in consecutive 
narrative. — Re-proving also to be taken in hand. — Conclu- 
sion 259 



THE 

KNOWLEDGE OF THE PHYSICIAN. 



I. 

THE KNOWLEDGE OF LIFE. 

Ladies ' and Gentlemen, — It is, believe me, with 
keen pleasure that I stand here to-day. American 
homoeopathy has always enlisted my warm sympa- 
thies ; but it has been with especial interest that I 
have watched the rise and progress of the Boston 
University School of Medicine, now in the second 
decade of its existence. That such a school should 
exist, without distinctive name, pledged to the 
method of Hahnemann only by the convictions of 
its teachers and the preferences of its pupils, — this 
makes actual my ideal of what should be. I would 
it were possible in my own country : I am very glad 
that it has become so in yours. While, therefore, I 
feel it an honour and pleasure to be invited to address 
American students, I am particularly gratified that 
Boston should be the place in which I am to speak. 

* The students of Boston University are of both sexes. 



2 THE KNOWLEDGE OF LIFE. 

In requesting me to deliver this course of lectures, 
my friends here have expressed certain wishes as to 
the topics of which they should treat. Their main 
subject-matter (it is allowed ) should be that to which 
I have given the best work of my life, and in the 
sphere of which I have made my poor contribution 
to our knowledge, viz. Materia Medica and Thera- 
peutics. But it has been thought well that discussion 
on this head should be preceded .by some consider- 
ations of a more general nature, bearing on Medicine 
as a whole. In deciding what these should be, I have 
been determined mainly by the nature of my audience. 
You are learners as yet, rather than practitioners : 
what you should knozv concerns you at present more 
that what you should do. At the same time, it would 
be a superfluous task to seek to augment your actual 
knowledge of the topics of medical education. To 
go again over ground which you have trodden under 
the leadership of such men as adorn this School 
would be labour in vain : if you have not learned — or 
are not learning — from them the physiology, the 
pathology, the pharmacology they teach, you would 
not learn it from another. But it has seemed to me 
that I might to your advantage draw you back a lit- 
tle from your fields of work, and ask you to take with 
me a survey of the country at large, — to enquire 
what is the knowledge you are seeking, both in itself, 
and in relation to the several departments to which it 
belongs and the action in which it ends. You are to 
practise the art of healing : you are acquiring the 
sciences accessory thereto, that you may fulfil your 



PHENOMENA. 3 

calling aright. What should you know of all of 
these ? what of each ? 

Every science - — that is, branch of knowledge, scien- 
tia from scire — consists of three parts, phenomena, 
laws, and causes. You may perhaps be thinking that 
phenomena are not peculiar to science, that they are 
matters of common observation. And so they are ; 
but common observation just differs from skilled, in 
that it very imperfectly takes them in. Night after 
night the host of stars circle around the pole, and the 
moon and planets wander about among them. All 
eyes perceive this ; but how few minds take in the de- 
tails of their order and march ! how few, for instance, 
when poets like Dante and Tennyson indicate the 
time of year by the positions then occupied by the 
constellations, can recognise the description and seize 
the indication ! He who has studied these and such- 
like phenomena has taken the first step towards ac- 
quaintance with the science of astronomy. And he 
has done more. He has mastered a series of facts 
which henceforth are part of the furniture of his 
mind, and can be turned to divers uses. Their per- 
ception necessarily affords pleasure, which all men 
can feel for themselves, and some can, by repro- 
duction of its sources, communicate to others. The 
poet can so describe the starry heavens, the painter 
so depict them, that quite a new sense of their 
wonder and beauty is wakened within men. It is 
thus that fine art lays hold of the knowledge of 
phenomena. But useful art employs it no less. 
One of the blessings which the Prometheus of 



4 THE KNOWLEDGE OF LIFE. 

^schylus claims to have brought to mankind is 
that he taught them 

*' The risin^: and the settins^ of the stars." 

From observation of these, of the sun's path among 
the stars, of the place of the pole and the phases 
of the moon, our progenitors drew a number of 
practical applications, to agriculture, to navigation, 
to the ordering of life and work, which made the 
lights of heaven — long before any real astronomical 
science had come into being — of large service to 
man, availing "for signs and for seasons, for days 
and years." 

I would lay the more stress on the value of knowl- 
edge of this kind, as it seems to me to have lost its 
place of late, alike in education and in appreciation. 
The world has been so fascinated by the discoveries 
of the last few centuries that these alone occupy its 
thoughts ; and to teach science means to impart 
knowledge of laws and causes, with very little refer- 
ence to the phenomena which those laws regulate 
and for which those causes account. It is the same 
tendency as that which dilates on the philosophy of 
history, disregarding its facts ; as that which makes 
books about great authors widely read, while few 
know the original works themselves. We shall see 
hereafter how disastrous such procedure has been in 
the study of medicine : at present we dwell on it 
only in relation to the subject of physical knowledge 
in general. Whatever else you learn, inform your- 
selves thoroughly as to/ac/s,—cis to all that can be 



LAWS AND CAUSES. 5 

elicited by observation and experiment. Nor take 
them only from teachers and books. See, hear, feel 
for yourselves: handle the instruments by which 
modern observation brings the distant near and the 
invisible into view, while at the same time you take 
in the great world of motion and sound, of colour and 
form, which is open every day to the unaided senses. 
Daily experience will warrant this counsel by the 
delight and profit it brings. 

But while I make thus much of the knowledge of 
phenomena — of the exercise upon nature of the 
perceptive faculties, I would not undervalue that 
of the intellectual. Man is made to enquire, to ask 
"how.?" and *'why.?" as well as "what.?" The 
answer to the two former questions constitutes what 
is called inductive science — the body of inferences 
more or less certain, of theories with stronger or 
feebler warranty, which are the result of thought and 
imagination when in the presence of natural facts. 
What a crowd of splendid conceptions rises in the 
mind when this reference is made ! The heliocen- 
trism of Copernicus, Kepler's laws of the heavenly 
motions, Newton's gravitation, the nebular hypothe- 
sis of Laplace, the undulatory theory of light and 
the dynamic of heat, morphological type and evolu- 
tionary growth in animated nature, — these are but a 
few of the most striking among them. They are all 
thoughts rather than observations ; of no necessary 
or even demonstrable truth ; open at any time to 
reconsideration on adequate challenge ; — but, while 
they stand, part of the world's richest wealth, lumi- 



6 THE KNOWLEDGE OF LIFE. 

nous in effect and indispensable to further progress. 
Because you are thinkers, and not merely perceivers, 
you must enter into these great thinkings of the 
giants of scientific discovery : from the vision of 
things as they appear you must rise to that which 
strives to see them as they are. 

These principles apply to knowledge in general : 
they characterise no less, of course, that knowledge 
which is necessary to the physician. He is, as we 
have said, the practitioner of an art ; and he might 
carry out his calling by pure empiricism and rule of 
thumb. At first he had so to do. But, by degrees, 
the life he has to guard and keep in health, the 
disease he has to combat, and the drugs he has to 
employ, have become the subject each of a science 
special to itself. Of these sciences — of physiology, 
of pathology, of pharmacology — you have to learn 
the phenomena, as ascertained by observation and 
experiment ; and no less to possess yourselves of the 
noumena, or what are believed to be such — the 
laws and causes of their workings as brought into 
view by intellectual vision. [I should say that by this 
word ''noumena" — from fov?, mind — philosophy 
designates the reality of things as distinguished from 
their appearances. This, however, is a metaphysical 
conception, — one of thought rather than fact ; and 
I am using the word more in its etymological sense 
to distinguish that which the vov^ perceives from 
that which the senses experience — both these being 
(probably) realities.] Let us pass in review to-day 
the phenomena and noumena of the first of these 



WHAT IS LIFE? *J 

sciences, or rather of that which is the subject of 
physiology — of life. 

The fundamental characteristic of that human body 
for which, as physicians, you will have to care, is 
that it is a living organism. The meaning of the 
latter term is obvious. It implies that the body is 
not simple, as a stone is, but complex in form and 
structure, its several parts so differentiated as to 
constitute distinct mechanisms capable of perform- 
ing various functions, and yet all bound together in 
unity of existence and (in some measure) of govern- 
ment. This it is to be an organism ; but what is it 
for such organism to be alive } A musical instru- 
ment, a watch, a printing-machine, answers to the 
definition just given: either is — or may be — of 
complex structure, having diverse parts subserving 
diverse purposes, but neither is living. What do we 
mean by characterising the human organism by this 
adjective ? 

We mean that it belongs to a class of existences, 
which includes all other animals and the whole vege- 
table kingdom, but excludes the world of earth and 
water. In all ages mankind has recognised the dis- 
tinctness of this class of beings, and has separated 
them off by ascribing to them the possession of a 
peculiar quality, which it has called ^wrj, vita, life. 
Plants and animals have life, they are living things, — 
this is the language in which mankind expresses a 
universal perception. The thought has sometimes 
been confused by the use of terms implying vitality 
tQ designate inorganic objects. The poet may indeed 
pardonably speak (like 3helley) of 



THE KNOWLEDGE OF LIFE. 



The living winds, which flow 

Like waves above the living waves below. 



or (like Virgil) of ''vivo sedilia saxo." But when 
philosophers tell us that minerals *' have a life of their 
own," they are employing language which is need- 
lessly misleading. Minerals exist, having their own 
laws and history ; but we want to describe that which 
is peculiar to plants and animals when we say that 
they live. 

Further consideration establishes what it is to live, 
wherein the differentia of living things resides. It is 
not that they have a definite form, into which they 
inevitably grow, and to which they compel all increase 
of their substance ; for this property they enjoy in 
common with the lifeless crystal. It is not that they 
are the seat of motion. There is no rest anywhere 
in nature : if to move were to live, all things would 
be alive. The earth and- its sister planets are revolv- 
ing on their axes, and whirling round the sun ; the 
sun itself and its brother luminaries are revolving on 
their axes, and circling some central point in space ; 
the ether is throbbing with undulations of light and 
the air with those of sound ; within the earth, the 
ocean is ebbing and flowing upon the shore, the riv- 
ers running to the sea, the winds above as restless 
as the tides below, the " clouds which far above us 
float and pause " ever resolving themselves and form- 
ing anew, heat is radiating and being absorbed, elec- 
tricity is producing its attractions and repulsions, its 
chemic combinations and decompositions, and — if 



VITAL GROWTH. 9 

we are to believe its latest imaginings — keeping 
every atom of matter in as restless a whirl as that 
which urges the suns and their worlds. Motion is 
not life ; nor does it become so by being spontaneous. 
We shall see hereafter that vital motions are not ini- 
tiations, but responses : yet, were they otherwise, 
that would not make them living, since the total mo- 
tion of the universe must — so far as science can 
pierce — be thus conceived of. (I mean, that you 
must go outside the universe to find its Mover. In 
itself it appears as self -moved.) Nor does life con- 
sist in growth and waste. We open our ears and 
hear 

" The sound of streams that, swift or slow, 
Draw down Ionian hills, and sow 
The dust of continents to be." 

Every wave upon the cliff, every shower of rain upon 
the land, is reducing one part of the earth to enrich 
another. In some places the land has risen, in others 
it has sunk, within the period of man's existence ; 
and the whole geologic history before him is one of 
continual growth and waste. 

While, however, growth by accretion is thus a phys- 
ical process, there is a growth which is purely vital. 
A granite rock to which chalk has been brought by 
rivers has no power of changing calcareous into gran- 
itic substance. But the plant and the animal, diverse 
as may be the structures of their several organs and 
the food supplied to them, can so transform this 
food within their bodies that it shall become homoge- 



10 THE KNOWLEDGE OF LIFE. 

neous with themselves, and go to make their wood, 
leaf, bone and muscle, and contribute to the texture 
of such special organs as the brain and the eye. There 
is nothing like this, save in living beings : it is a 
purely vital process. And as their growth is not 
mere accretion, so the correlative waste in them is 
more than separation. Matter is thrown off from the 
tissues in lower forms than those in which it exists 
there : muscular fibre is eliminated as urea, nervous 
substance in the shape of phosphates. 

Growth by assimilation is thus the first process 
characteristic of life. And the second is like unto 
it, — it is the reproduction of the kind. This is a 
power peculiar to plants and animals, and nothing 
bearing the remotest resemblance thereto exists in 
any but living beings. It also, therefore, is purely 
vital, and constitutes an element in life. 

Take now the whole life -history of a plant, and we 
shall find it comprised in these two processes — 
growth by assimilation and reproduction of its kind, 
the means for the preservation of the individual and 
the perpetuation of the species. All else about it is 
physical, common to the world around : these are 
peculiar, are vital. Since, then, any property which 
does not belong to the vegetable creation cannot be 
essential to life as such, we may consider these two 
as making up the manifestation of that which we 
name vitality. Pressing our analysis farther, we find 
the duality resolving itself into unity ; for in the lowest 
forms of life generation is no distinctive process, but 
a simple fission or gemmation — a portion of the liv- 



PROTOPLASM. 1 1 

ing mass becoming detached, and then growing by 
assimilation into the parent form. (Microscopically, 
indeed, reproduction and growth are in all cases 
identical, consisting essentially in the cleavage and 
duplication of cells ; but I speak of them as they ap- 
pear to the common eye.) Now in these primitive 
regions, among the dim beginnings of things, another 
fact is pressed upon our notice. It is that the essen- 
tial functions of life require for their basis none of 
the developments seen in the higher plants or ani- 
mals. Tracing these down as they slope towards a 
fellow, if not a common, root, we come at length to 
creatures like the amoeba. We have here neither 
colour nor (permanent) form ; solidity and structure 
alike are absent ; and yet no one can doubt that the 
amoeba lives. Retracing then our steps, we find that 
as we ascend the scale of being, either along the 
vegetable or the animal side of the slope, we always 
carry what we may call amoeboid matter with us. Be- 
hind all shapely form, within all solid envelopes, is 
the structureless, transparent, colourless, semi-fluid 
substance we have seen floating in the waters. We 
call it protoplasm — not a good word, for it is rather 
the first to form than the first to be formed. But, 
however it be named, it must be conceived of as the 
seat, and the only seat, of vitality — this property 
being fully manifested when it alone is present.^ Of 
ourselves we may say, non ovinis vivo: we are not 

^ " Wherever there is life, from its lowest to its highest manifestations, 
there is protoplasm ; wherever there is protoplasm, there also is life " (Pro- 
fessor Allman, Brit. Assoc. Report, 1879). 



12 THE KNOWLEDGE OF LIFE. 

alive in every part. The fluids of the body do not 
live, any more than water does. Hair, nails, teeth, 
bone, are when once formed as lifeless as similar 
matter existing elsewhere ; and the same is demon- 
strably, though not so obviously, true of cartilage, 
fibre, cuticle, and all cell-walls and sheaths.. The soft 
matter which most of these contain — the contents 
of the cell, the pulp of teeth, the marrow of bone — 
this lives and forms its envelope ; but the thing 
formed, that which has structure, rigidity, colour, has 
passed from life to death. As dead, it is continually 
decaying, but as continually being replaced by its 
indwelling protoplasm, which takes from the food, 
reaching it as blood, the material for the purpose. 

Life is thus a property belonging to matter in that 
peculiar state which we denote by terming it " liv- 
ing ; " and such living matter, though everywhere 
present in the organism, constitutes but a small part 
of the bulk of the frame. The first to promulgate 
this doctrine was one whom we of the school of 
Hahnemann may fairly claim for our own ; for though 
he never practised, and died before homoeopathy be- 
came a living thing in his country, he welcomed it 
and vindicated its claims to attention. I speak of 
Dr. John Fletcher, of Edinburgh. His Rudiments 
of Physiology, published between 1835 and 1837, 
start from the theory first propounded by Brown in 
1780, that life is the result of the action of the 
natural stimuli — light, heat, oxygen and so forth — 
on the ''irritability" of the tissues. Their capacity 
of responding thereto is vitality : their actual re- 



FLETCPIER AND HIS DISCIPLES. 1 3 

sponse is vita — life. This view — espoused by all 
the great naturalists and physiologists who had 
followed, by Blumenbach, Cuvier, Bichat, Magendie, 
Pritchard — is maintained by Fletcher, and opposed to 
all theories of a "vital principle," in a series of chap- 
ters which, as Dr. Drysdale justly says, "for learning, 
wit, close reasoning, and splendour of diction, have 
been seldom equalled, and, I venture to say, never sur- 
passed in the literature of physiology." But Fletcher 
went farther, in perceiving and meeting the difficulty 
that much of the organism seemed to be irresponsive 
to stimuli. He did so by arguing that it is indeed 
not wholly alive ; that its fluids and hard solids have 
no more vitality than water or wood. The old phrase 
"materia vitae diffusa" after all expressed the truth ; 
only it was a "materia" indeed, and nothing semi- 
spiritual — a living matter everywhere found where 
life is manifested, and constituting the substratum of 
its phenomena. That such a matter there must be, 
he clearly discerned and irrefragably proved. But he 
unfortunately went farther still, and thought he had 
found it in the ganglionic nerve-substance. This error 
caused his work to be doubtfully received and soon 
forgotten. There were two of his pupils, however, 
who held his memory dear, and waited for the time 
when his discernment would be vindicated. Both 
have adorned our ranks. One was Dr. Rutherford 
Russell, a man of no common power and charm, too 
early lost to us. The other I have already named, 
and to name him is sufficient : it was Dr. Drysdale. 
He had not IpPg to )yait. In 1861, Professor Lionel 



14 THE KNOWLEDGE OF LIFE. 

Beale, of King's College, London, proclaimed as the 
result of long-continued microscopical study that the 
substance already recognised in plants and the lower 
animals, and known as '' sarcode " or ''protoplasma," 
— that this structureless, transparent, colourless, 
semi-fluid stuff, is universally diffused throughout the 
human organism, and everywhere manifests distinc- 
tive vital characters, separating it from the "formed 
material " around. Into this it dies daily, just as the 
whole organism dies into its post mortem condition, 
when the mainspring of its common existence has 
been broken. But, till then, the ''germinal matter," 
while ever perishing at its circumference, is ever re- 
newing itself at its centre, converting the pabulum it 
takes up into its own living substance, instinct and 
quivering with vital motion. All this Beale proved 
as a fact which none could gainsay ; but the scientific 
world at large was hardly ripe for the theory of life 
which followed. Drysdale, on the other hand, pre- 
pared by Fletcher, recognised it as that which he had 
all along been holding, and saw in protoplasm the 
very materia vitcB whose existence his master had 
demonstrated, but which he had mistakenly identi- 
fied. At once, in the British Journal of HomceopatJiy, 
he commenced a series of papers on the subject, cul- 
minating in his separate publications entitled '' Life 
and the Equivalence of Force" and ''The Proto- 
plasmic Theory of Life." ' Here, While others were 
hesitating, he boldly grasped and vindicated the doc- 
trine ; and he had the gratification in 1879 of hearing 

"^ Published by Bailliere. 



PROTOPLASM AND ETHER. 1 5 

it proclaimed as generally accepted from the Presi- 
dential chair of the British Association. Professor 
Allman there happily compared the place which pro- 
toplasm occupies in the mind of the biologist to that 
which the ether takes in the conceptions of the phy- 
sicist. You know that, as sound consists of waves of 
air, transmitted from a vibrating body to our percip- 
ient organs, so light and heat — to go no farther — 
are best understood when regarded as undulations of 
some fluid medium. This cannot be the atmosphere, 
which extends only some forty miles above the earth's 
surface, while heat reaches us from the sun and light 
from the most distant of the fixed stars. We have 
therefore to assume the existence of an "ether," fill- 
ing all interstellar space, as much finer than air as air 
is than water, and in like manner filling its " void and 
bare interstices." Protoplasm, as "co-extensive with 
the whole of organic nature — every vital act being 
referable to some mode or property of it — becomes 
to the biologist what the ether is to the physicist ; 
only that instead of being a hypothetical conception, 
accepted as a reality only from its adequacy in the 
explanation of phenomena, it is a tangible and visible 
reality, which the chemist may analyse in his labora- 
tory, the biologist scrutinise beneath his microscope 
and his dissecting-needle." 

I am, I confess, desirous of pressing this concep- 
tion upon you, on account of the part it must neces- 
sarily play in your thoughts about the system of 
Medicine you have adopted. Homoeopathy is not a 
philosophy, but a method : yet it has a philosophy, 



l6 THE KNOWLEDGE OF LIFE. 

and it is important that this should be clear and sound, 
and in harmony with the best thought of our time. 
Hitherto our notions of life have mostly been those 
enunciated by Hahnemann, In his student days it 
was always assumed to be a principle, distinct from 
the organism it animated, — the only question being 
whether Stahl should be followed in identifying it 
with, or Hoffmann in distinguishing it from, the im- 
mortal soul. When, in later life, he began to think 
upon the subject for himself, he espoused Hoffmann's 
doctrine, though with much more philosophic grasp. 
The vital principle with him was no entity, but a 
"force," and in conceiving it as such he anticipated 
(in 1829) the notion of force now everywhere current. 
'' The organism " he wrote ( in the edition of the 
Organon that year published ) "is indeed the material 
machine to the life, but it is not conceivable with- 
out the animation imparted to it by the instinctively 
perceiving and regulating vital force, and tJie vital 
force is not conceivable withont the orgajiism, conse- 
quently the two together constitute a unity, although 
in thought our mind separates this unity into two 
distinct ideas, for the sake of facilitating the appre- 
hension of it." The "vital force " is thus, with him, 
the mode of motion of the living organism. 

Through Hahnemann such views of life have gen- 
erally gained acceptance in the school which he has 
founded. They have, moreover, been reinforced among 
us from another and independent centre. In 1849 
the distinguished French physician, Tessier, cam.e 
over to homoeopathy, and brought with him a brilliant 



THE ANIMATING PRINCIPLE. 1/ 

band of disciples. But he was more than a physician : 
he too was a Master, and taught a complete system 
of medical thought. His doctrine of life was that of 
the Thomists, the followers of St. Thomas Aquinas. 
It is fully set forth in the Elements de PatJiologie of 
the present coryphaeus of the school, Dr. Jousset — 
one of the ornaments of our body. We are there 
told that the cause of life, of that which makes living 
beings distinct from others, is an ''animating prin- 
ciple," which, existing already in the germ, preserves 
it from corruption, fashions the organism into which 
it grows and regulates all the functions of the same, 
until its final retirement therefrom results in death 
and dissolution. This animating principle also, like 
Hahnemann's vital force, is said to be so intimately 
united with the matter of which it is (in philosophic 
language) the "form," that the two are inseparable, 
— their union constituting the living being, one and 
indivisible. But the Thomist doctrine has the dis- 
advantage of lineal descent from that of Aristotle, 
and adopts his terminology. The result is that it 
speaks of the animating principle of a plant as the 
vegetative soul ( ^A^^x^, anivia ), and as it uses similar 
language regarding the life of man, it seems to iden- 
tify his soul with his vital force, and indeed to give 
him one at all in no other sense but that in which a 
cabbage has one. Moreover, if ''anima forma cor- 
poris " is to be the canon (and our confreres are so 
fond of this phrase that for many years it has served 
as a motto for their journal, L Art Medical), — if 
the soul is the form of the body, and we go to Aris- 



1 8 THE KNOWLEDGE OF LIFE. 

totle to learn what is meant by ''form," we find him 
ilUistrating it by saying that vision is the form of the 
eye. The soul, then, so conceived, has not and canr 
not have any existence independent of the body of 
which it is the function, — a conclusion tolerable 
enough as regards animals and plants, but not to be 
readily entertained by man, who *' thinks he is not 
made to die." It is a conclusion, I should say, which 
would be warmly repudiated by the school of which 
I speak, which is distinctly Christian in its thought ;. 
but it is one to which logic must remorselessly lead 
them.' 

Is such an ''animating principle" required to ac- 
count for the facts of the case ? It is argued by 
Dr. Fredault, another worthy inheritor of Tessier's 
thoughts, that its existence alone will explain the 
growth of the germ into the parental form. But 
crystallisation presents similar morphological phe- 
nomena, and no "ame minerale " is even supposed to 
be working here. It is perhaps easier to conceive of 
death by calling this its "retirement : " but if it re- 
tires, where does it go ? Christian philosophy gives 
an at least intelligible account of the future of the 
disembodied spirit ; but what can be thought or said 
of the separate existence of the bodily life • — of the 
bodily lives of the million creatures that perish every 

^ Mr. St. George Mivart, who represents in England the same CathoHc 
philosophy, would describe the ^vxv as a " principle of individuation," and 
would grant its non-existence apart from the body. But he does not grapple 
with the difificulty in relation to man, save by suggesting that in his peculiar 
case there may be some interference with the ordinary law ( Brit. Assoc. Re- 
port^ 1879. Biological Section). 



LIFE A MUSIC, 19 

moment ? Is it not much better to conceive of it as 
the ''splendour and music" which "survive not the 
lamp and the lute " ? Indeed, this last image, sug- 
gested by one of the interlocutors in the Phcedo as 
representing the soul itself, and so casting doubt on 
its immortality, may well be applied to our present 
subject. Socrates (or Plato for him ) has no diffi- 
culty in showing that the soul is more than the har- 
mony of the body ; but this is just what life is. It is 
a music, of which the organism is the instrument, and 
the natural stimuli the players, — secondary players 
indeed, for the great Musician who out of the diverse 
tones they elicit brings pure melody and perfect har- 
mony is the Creator and Sustainer of all things, of 
whom Hahnemann was the constant worshipper, and 
whose reverent acknowledgment will I trust be always 
a feature of the school which calls him master. 

You will observe that in all this I have been say- 
ing nothing of the distinctive faculties of man — of 
thought, and love, and conscience, and will. I have 
spoken only of the life which he has in common with 
the beasts that perish, aye, and with the plants of 
the field. His higher life may well have for its sub- 
stratum some entity of another kind, some substance 
which we can only characterise by calling it spiritual. 
Hahnemann avoided the dilemma of the Thomists by 
distinguishing the vital force from the rational and 
immortal soul. But his conception of life as a 
''force," though philosophically tenable, lacks scien- 
tific warrant. The forces are affections of matter, 
modes of its motion, correlative and interchangeable 



20 THE KNOWLEDGE OF LIFE. 

among themselves, and amenable as matter itself to 
the law, "■ omnia mutantur, nil interit. " But matter has 
other qualities besides these — often casual — affec- 
tions : it has inherent properties, which make it and 
its various forms what each essentially is. Accord- 
ing to its properties it is influenced by the natural 
forces : its chemical affinities determine how it shall 
act under chemical attraction, its responsivity to 
magnetism makes it advance towards a magnet when 
presented to it. Is life, then, a force or a property ? 
Clearly the latter. Vitality is, as I have said, the 
living matter's capability of response to the natural 
stimuli ; and the life of each individual is that re- 
sponse on its part, conditioned by its own special 
constitution. Some of these stimuli — as light and 
heat — are themselves forces, and the work done 
under their influence is of course an expenditure of 
energy equivalent to that which they convey. But 
to dead organic matter they appeal in vain, — not 
that they are less stimulating, but that it has no 
longer the capacity of answering to the prick of the 
spur. 

The importance of this conception in our philoso- 
phy of homoeopathy is that it keeps us clear of meta- 
physics, that it enables us to be dynamists without 
being spiritists. Hahnemann did not always main- 
tain the lucid idea of the vital force whose expression 
I have read you from the Organon. He frequently 
speaks of it as something distinct from the organism 
it inhabits — an archceiLS regulating its development 
and motions. Revolted by the gross humoralism 



DYNAMISM NOT PNEUMATISM. 21 

of his day, he retreated beyond solidism into pneu- 
matism : he taught that all disease originated in a 
derangement of the vital force, physical changes 
being only secondary. The exciting causes of dis- 
ease, especially the infectious principles, must there- 
fore be non-material ; and in like manner the drugs 
which modify it for good must be so attenuated as 
to part with their physical envelope, and become 
something new and spirit-like. I am not prejudicing 
the question of dose : I am rather protesting against 
its being prejudged by the assumption that the seat 
of medicinal action is an invisible, intangible *' force." 
Recognise that it is living matter — protoplasm ; and 
then you have all that dynamism can desire, without 
the need of any such untenable theory as " dynami- 
sation." You have matter in its most sensitive, 
responsive state, capable of modification by the finest 
germs or molecules ; but it is matter still, requiring 
its morbific contao;ia, its sanative medicines, to be — 
however minute — material also. This Science also 
requires, for (in the natural world) she knows of no 
force apart from matter, none that is not resolvable 
into the motion originally impressed upon the atoms 
of the Universe by their Creator. The amount of 
energy contained in and put forth by matter varies 
indefinitely, and we avail ourselves of the variations ; 
but to think that we can escape from the matter and 
retain the energy is a delusive dream. I hope that 
no student of Boston University, of the Medical 
School which has Conrad Wesselhoeft among its 
Professors, will ever dream it. 



II. 

THE KNOWLEDGE OF HEALTH. 

The subject of medical art being the human or- 
ganism, there are two things which the physician has 
to do for it : he has to preserve it in health, and — 
when necessary — to free it from disease. In the 
execution of the first of these tasks he is a hygienist, 
in the second a therapeutist. It is of the health-pre- 
serving duties of the physician that I am to speak to- 
day. In allotting no small space to this subject I am 
but treading in the footsteps of the master of our 
school. It is sometimes ignorantly represented that 
Hahnemann was a mere drug-giver, that — as Dr. 
Bristowe has said — ''for him, preventive medicine, 
which deals specially with the causes of disease, and 
has been successful only in proportion to its knowl- 
edge of them, would have been a mockery and a 
snare." So far is this from the truth, that in his first 
homoeopathic essay of 1796 Hahnemann speaks of 
the removal of causes as the most elevated way which 
practical medicine can follow, as a "royal road; " and 
in his Organoii, from its first edition in 18 10 to its 
last in 1833, he begins by assuming that both to pre- 



HOMCEOPATHY AND HYGIENE. 23 

vent disease, and to make his curative treatment 
unobstructed and permanent, the physician will also 
be a hygienist. These precepts are well illustrated 
by his own example, as seen in his letters of advice 
to patients extant here and there in our literature. 
He, indeed, who anticipated Pinel in a rational and 
humane treatment of lunatics, was not likely to have 
neglected the general management of his sane pa- 
tients ; and his writings prior to the time of his special 
occupation with his therapeutic method frequently 
touch on the subject. In so acting he has been fol- 
lowed by his most genuine expositor on American 
soil — the late Carroll Dunham ; who, in his "Homoe- 
opathy the Science of Therapeutics," begins by defin- 
ing the sphere and emphasising, the importance of 
hygiene. In the same spirit have many of the homoe- 
opathic physicians of the United States taken active 
part in the Pubhc Health Associations of their coun- 
try ; and one of the foremost European hygienists — 
Dr. Mathias Roth — belongs to the homoeopathic 
body in England. 

It could hardly, indeed, be otherwise ; for the 
method of Hahnemann in its very nature links itself 
with healthy living. Its single, clean, mostly taste- 
less and inodorous remedies suggest a regimen equally 
simple and pure : the gentleness of its medication 
consists only with a like non-perturbative dietary. 
He that dispenses with narcotics and blisters in ill- 
ness will hardly abuse stimulants and condiments in 
health. The importance we attach to drug-giving 
makes us the more anxious to banish all that is medi- 



24 THE KNOWLEDGE OF HEALTH. 

cinal — that is, poisonous — from our patient's sur- 
roundings, and so to secure for him the prime 
necessities of health — fresh air, pure water, and 
wholesome food. We are thus hygienists in virtue 
of our method ; and still more because we are not 
homoeopathists only, but physicians, and — niJiil de 
hiimano coi'poi'e a nobis alieniun putamus. 

Milton has said that a poet's life should itself be a 
poem ; and I would apply this saying to the physician. 
He who preaches healthy living should himself prac- 
tise and illustrate it. With what force can he enjoin 
moderation at table if he is a bon vivant ? how can he 
warn his patients against nicotinic intoxication if he 
smokes all day .^ And more, — he must see that his 
very virtues do not lead him to excess : he must re- 
strain himself from the noble folly of overwork, that 
he may with greater effect reprove it in others. He 
ought to be able to say, — by the observance of the 
principles I commend to you I am myself a healthy 
man, able to do a full life's work with strength and 
joy. Of course there must be exceptions to such a 
statement — cases where an unhealthy tendency has 
been inherited, or accident has invaded and broken 
the constitution. But even here much may be done : 
if it could not be, how could we expect patients simi- 
larly circumstanced to place themselves in our hands .? 
When all allowances have been made, it remains true 
that the physician should exemplify the ideal he holds 
up, and lead as well as point the way to health. 

This is the first duty I would lay upon you in con- 
nexion with hygiene ; and the next is that you should 



EXERCISE. 25 

have clear conceptions as to its constituent elements. 
Hygiene may be defined in brief as man's due care 
for himself and proper selection of his environment. 
His body needs exercise, rest, warmth, air and food. 
The first two it can give itself, and the third it can 
to some extent supply ; but air to breathe and food 
to eat come to it from without, and health largely 
depends on the quantity and quality in which they 
are furnished to it. Let me say a few words on each 
of these heads. 

I. The recommendation of exercise is a time- 
honored function of the physician, and probably in 
Hippocratic times it was prescribed with as much 
minuteness as medicines are at present. It forms 
now as ever a prime necessity of health and adju- 
vant to recovery ; and to its hitherto-known varieties 
of walking, riding, driving, swimming, and gymnas- 
tics, we can add the several kinds of "cycling" and 
the "massage." Let us think, however, why it 
is that exercise is desirable. It is so because the 
more rapidly the effete portions of our organism can 
be carried off, and replaced with new matter, the 
higher our health and efficiency. Exercise promotes 
this moulting, by quickening the blood-current and 
increasing the secretions ; while the waste thus in- 
duced causes appetite — a demand for food to supply 
it, and thus deposition of fresh tissue. The enor- 
mous quantity of nutriment which can be taken and 
digested by the subjects of Dr. Weir Mitchell's treat- 
ment, while undergoing vigorous massage, well illus- 
trates this point. One sees, therefore, on what class 



26 THE KNOWLEDGE OF HEALTH. 

of persons exercise should be enjoined. The young 
hardly need the admonition, — the problem of per- 
petual motion going far towards solution with them ; 
and the old should not receive it, for, their power of 
repair being feeble, it is unadvisable to precipitate 
waste. It is the middle-aged — embracing in this 
category all lives from twenty to sixty ; and among 
them those of luxurious or studious habits, and those 
whose occupations are sedentary. Such persons 
may with little exercise strike a sort of secondary 
balance — may compensate insufficient outflow with 
moderate in-put, and so establish a working equilib- 
rium ; but they know little of the sensation of puis- 
sant life and the buoyant energy for work which 
comes of active exertion and hearty feeding. 

2. In the present day, perhaps, rest has to be en- 
joined more frequently than exercise. It is an age 
of overwork ; and nothing is more common than to 
hear, both in public and in private life, that such and 
such an one has been ordered by his physicians to ab- 
stain entirely from work for a longer or shorter time. 
You must of course not shrink from giving such ad- 
vice when it is necessary. But on the one hand I 
would urge upon you not lightly to lay such an obliga- 
tion on your patients ; to put yourself in their place 
before you do so, and realise the serious consequences 
it involves. I do not know how it is on this side of 
the Atlantic ; but on ours it is becoming quite a fash- 
ion to ''order away " every troublesome case on which 
a man is consulted, without considering what this- 
means for the sufferer, and instead of taking pains to 



REST. 27 

see whether by medication and wise regulation of life 
so revolutionary a change might not be averted. This 
I say on the one hand ; and on the other I would com- 
mend to you the cultivation of preventive medicine 
here. The physician should preach — in season and 
out of season, he should also practise and exemplify, 
the place of rest in life. I have called overwork a 
noble folly,. and sometimes indeed the adjective has 
more truth in it than the substantive. Of one of our 
ancient kings — and here the ''our " belongs alike to 
you and to me, to the Anglo-Saxon race throughout 
the world ; of Alfred the Great it is related that he 
divided his day into three parts, giving eight hours 
to the cares of state, eight to study and writing, and 
allowing only the remaining eight for repose, recrea- 
tion, exercise and meals. It was perhaps needful for 
him so to expend himself, and the nobleness of his 
devotion has enshrined him in the reverence of all 
succeeding ages ; but it is little wonder that for most 
of his life he was racked with painful disease, and 
that he died worn out at fifty-two. I advise no one 
for lesser cause, and a fortiori not for ambition or gain, 
to allow so little breathing-space in life for rest and 
leisure. To a man in active work eight hours are 
none too much for sleep alone ; and if^another eight 
are allowed for the care of the body and the play of 
the lighter faculties I am sure that the work done in 
the time which remains will be all the better in qual- 
ity. It will be this, and it will go on longer. There 
will not be the tragedy so often enacted in these days, 
of a man in the prime of his powers and usefulness 



28 THE KNOWLEDGE OF HEALTH. 

more or less suddenly ''breaking down," all his ac- 
cumulated force and experience lost to the world 
because he had not husbanded his strength. This 
wisdom must be preached ; and so must that be which 
lifts a warning against the feverish haste, the over- 
pressure, of our present mode of existence. Men 
try to make up for it by taking long holidays ; but 
these — even if themselves not spent in hurrying 
through foreign sights and sensations — do not make 
up for the lack of daily repose. The heart, that tire- 
less worker, sets us an example here, for it rests 
during a fourth part of every pulsation, and beats at 
an almost uniform rate all the day long. Why should 
not we work thus evenly, rest at least thus propor- 
tionately .'* 

3. About ivarmth, I apprehend the most impor- 
tant truth to be that the body makes its own heat, 
has its hearth and furnace within itself. How few 
people realise that the main use of clothing is to keep 
in the caloric which the frame has generated — any 
end it may subserve in protecting from draughts of 
air being quite subsidiary ! In choosing warm cloth- 
ing, therefore, it is not so much quantity or thickness 
we have to study, as that the material shall be non- 
conductive of heat, and its fit such as to allow space 
for a stratum of warm air near the body. And, even 
here, it ought to be borne in mind that it is the sen- 
sation of warmth we are conserving rather than its 
actual existence. Nature has so bountifully provided 
for us, that no change in environment makes much 
difference in our internal temperature^ — cold to the 



THE SENSE OF WARMTH. 2g 

surface only stimulating heat-production, as a fervid 
atmosphere is compensated by increased heat-radia- 
tion. Thus the normal warmth of the body — that 
which is necessary for the due performance of the vital 
processes — rarely suffers loss, so long as fuel can be 
supplied in food, and combustion kept up by exercise. 
That which fluctuates is the sense of warmth, which 
is due to the state of the tissue in which the sensory 
nerves of temperature terminate — the skin. If the 
cutaneous arterioles are sufficiently open, and the 
heart pumps the blood freely through them, we feel 
warm, and so are comfortable. Now life without 
comfort is hardly worth living, and so the sense of 
warmth is to be cultivated. Sometimes its absence 
is a real morbid condition, and we have medicines to 
help us here, — drugs like Asarum and Ledum, which 
make healthy persons chilly. But more commonly 
the deficiency is a matter of hygiene, and can be sup- 
plied by improving the state of the skin. Foremost 
among the measures available here is that which we 
English affectionately call our "morning tub" — the 
cold bath taken immediately on rising. I speak not 
of it now as it conduces to cleanliness, — for this 
may be otherwise secured. I am regarding it as a 
means of making the skin less sensitive to external 
cold, — of approximating the whole surface to the 
callousness of the face, which we expose to the coldest 
blasts without distress or peril. I am thinking also 
of the glow which follows, and which is so readily 
renewed by food, and exercise, and warmth from with- 
out. Every man or woman who can take a cold bath 



30 THE KNOWLEDGE OF HEALTH. 

in the morning should have it, and will be the happier 
and the healthier for it. 

But there are cases in which heat-production is 
absolutely below the normal standard, and vitality is 
lowered in proportion. Here again we may have 
a true — that is, primary — morbid condition, and 
specific medication may come to our aid. One of the 
most interesting things in Dr. Burnett's essay, '' Na- 
trum muriaticum " (which I trust you have all read, 
or will read), is the effect of that remedy in promot- 
ing the calorifacient function. Calcarea carbonica 
probably has a similar action, though its coldness is 
rather felt locally — as in the head or legs — than 
generally. But here also the defect is more com- 
monly a physiological one, and amenable to hygienic 
measures. We have only to think over the sources 
of animal heat to see how much may be done by 
judicious regimen to increase its production, as by 
urging exercise — active or passive, and supplying 
readily-oxidised food. At the two extremes of life, 
indeed, our aim is somewhat different. In the very 
young heat is formed freely enough, but too readily 
lost ; and you can hardly be too earnest with mothers 
that they should clothe their children warmly, and 
not sacrifice health and comfort to appearances. In 
the aged, little can be done for the making of heat : 
it is its supply from without to which we must attend. 
Warmth to the surface, warm air to breathe, are our 
adjuvants here ; and especially helpful are hot drinks, 
which add positive caloric to the system, and — for 
the time at least — inspirit all its functions. 



SEWER-GAS. 3'1 

4. That the air we breathe should be pure is per- 
haps the best-learned lesson of hygienic science. All 
educated persons recognise the truth, and nearly all 
act up to it so far as supply of oxygen and elimina- 
tion of carbonic acid are concerned. But our modern 
sanitary arrangements, with all their advantages, 
have brought into being a new agent wherewith to 
contaminate the atmosphere : I refer to sewer-gas. 
I am sure that we cannot be too much on the alert to 
detect the possible existence of this causa viali ; and 
the disconnection of drain-pipes will often do far 
more for our patients' health — to say nothing of our 
own reputation — than the most carefully selected 
medicines. A good instance of the subtle way in 
which sewer-gas will act is supplied by our recent 
literature. In the Monthly Honia^upathic Rcviciv for 
January, 1879, Dr. Edward Madden related a case of 
erysipelas occurring in a child of his after vaccina- 
tion with calf-lymph. His inference was that the use 
of this matter does not secure immunity from such 
accidents. In the April number, however, appeared 
a letter from Dr. Edward Blake asking Dr. Madden 
if he was sure about the state of his drainage, as he 
had lately traced a post-vaccination erysipelas to a 
fault in this direction. In August Dr. Madden re- 
plied, saying that investigation had shown his house 
to be "exposed to nearly all the dangers of admit- 
ting sewer-gas to which defective arrangements 
could conduce." Dr. Blake has indeed made the 
subject his own, and supplies another instance of a 
member of our body being an earnest hygienist. In 



32 THE KNOWLEDGE OF HEALTH. 

his brochure entitled " Sewage Poisoning : its causes 
and cure," ' he shows how perilous is this taint in the 
air to the subject of an operation or the parturient 
woman, and traces to its influence many forms of 
ill-health, as diphtheritic throats, morning headache 
and diarrhoea, unaccountable languor, anorexia, fever- 
ishness, and sleeplessness, passing on — especially 
in children — to anaemia and glandular suppurations. 
To these probably every man's experience would sup- 
ply additions, — I, for example, having seen ascarides 
in an adult obstinately persist while it was present, 
and immediately clear away on its removal. Sewer- 
gas cannot of itself initiate a specific disease, but it 
both spreads its germs and predisposes to their re- 
ception, and then — when the malady has been set 
up — tends to make it malignant, and — if the patient 
recovers — to retard his convalescence. Whenever 
there is an x in the morbid conditions with which 
you have to deal — some unknown factor making 
everything go badly and defeating your most just 
anticipations, there suspect sewer-gas, and look to 
the drainage. 

The air we breathe must be pure, and it must be 
suited to any weakness — any vulnerability which 
may exist in our constitutions. In health " man is 
man, and master of his fate :" he can subdue to his 
purposes the greatest extremes of climate as he can 
the beast of the field, the fowl of the air, and what- 
soever passeth through the paths of the seas. But 
let his system once give way at any point, and his 

^ Spon; i6 Charing Cross, London, and 446 Broome Street, New York. 



CLIMATE. 33 

mastery is over : non vincit, now, sed pareundo. He 
must find the spot of earth best suited to his pars 
minoris resistentice^ if the rest of his frame is to 
flourish unimpaired. This choice of cKmate fre- 
quently falls to the physician to determine, and we 
must be prepared to advise alike with sound princi- 
ples and with knowledge of their practical applica- 
tion. There is nothing in which we need so specially 
to individualise as this. The total which we call 
climate is the product of several factors, — latitude, 
exposure, elevation, soil, water, all go to make it up ; 
and it is the whole which we must estimate and fit. 
Nothing is more instructive than the maps of the 
British Islands which Dr. Haviland has framed, 
showing by diverse colouring the tracts more or less 
favourable to the development of consumption and 
cancer. Inductive generalisation can perhaps estab- 
lish some common features here — defective flow of 
air in the one case, saturation of soil in the other ; but 
for the present the individual facts are our most im- 
portant knowledge. Again, what is more significant 
than the fact elicited by Dr. Chambers, that in Italy 
chronic degenerative maladies like Bright's disease 
play a very small part among the causes of mortality 
compared with Great Britain } Residence there, when 
practicable, is obviously the best resource for those 
so afflicted. The value of mountain-air, though cold, 
for phthisical subjects is another fact of the same 
order. You doubtless have, in the vast extent of 
your States, an England and an Italy ; a Riviera or 
Madeira for your delicate-chested, a Davos for your 



34 THE KNOWLEDGE OF HEALTH. 

true consumptives. Study them individually, as we 
have had to study the health-resorts of Europe ; and 
you will have in climate a most potent agent at your 
command. 

5. We come now to the important subject oi food, 
and with this must occupy ourselves for the remain- 
der of the present lecture. 

Why must we eat } That nature prompts us so 
to do by the calls of appetite, and sternly punishes 
any failure to attend to her admonitions, is obvious 
enough: but what does science say on the subject.'* 
for what end or ends do we take food 1 This ques- 
tion is (I think) best answered by the old comparison 
of the body to a steam-engine, whose fire is vitality, 
and which needs fuel that it may perform work. The 
human engine differs indeed from its mechanical 
type that it has, at one stage of its existence, to 
grow, and throughout its continuance to repair its 
own waste. For these purposes food is required as 
substance, to make the tissues which need augment- 
ing or replenishing ; and until lately this (with the 
supply of heat) was looked upon as its sole office. 
Now, however, we have come to see that in the adult 
body there is not much waste ; that its floating cap- 
ital is small in proportion to its actual assets. If, 
then, repair were the sole use of food when supply 
for growth was no longer needed, the demand for it 
would be very small. But the doctrine of force in 
modern science has taught us that for all v/ork done 
energy must be expended, and so — if the work is to 
continue in doing — must be renewed. For its sup- 



FOOD THE FUEL OF LIFE. 35 

ply the main source is the aliment. I doubt not that 
this is (mostly, for there are exceptions) assimilated 
before it is oxidised — that it is its own substance 
which the animal steam-engine burns, and not di- 
rectly the coal. But so rapid is the conversion, so 
unstable the product, that the pabulum may fairly 
be regarded as the fuel for the flame, and the imme- 
diate source of the motive-power of the body. 

"The human body" says Hermann, "like that of every other 
animal, is an organism in which, by the chemical changes of 
its constituent parts, potential is converted into kinetic energy. 
. . . These chemical changes depend on the presence, within 
the organism, of energy-yielding substances. . . . Every act of 
the organism must diminish, to a corresponding extent, the 
energy-yielding- store which it contains. ... It is, therefore, 
essential, in order that the organism should continue to exist, 
that it be continuously supplied with oxygen and oxidisable 
substances. The latter are called the organic constituents of 
food." 

He goes on to show that the inorganic elements of 
our diet, besides any mechanical {e.g. solvent) uses 
they subserve, supply the waste of the same substances 
which form part of the body ; but do not furnish it 
with energy. 

Even stated thus, it appears that food is the fuel 
for the fiame of life. But we may go farther when 
we regard those dialytic processes which are not 
oxidations, and in which aliments are decomposed 
immediately without previous assimilation. What 
occurs when sugar — or, what ultimately comes to the 
same thing, starch — is ingested.? It is converted. 



36 THE KNOWLEDGE OF HEALTH. 

into lactic acid, a substance of much lower equivalent 
value ; and thus energy is directly evolved A sim- 
ilar thing happens with fats, where — mainly under 
the influence of the pancreatic juice — the stearine (or 
what corresponds to it) is broken up into stearic acid 
and glycerine ; and this prior to assimilation. Here 
are liberations of force occurring in the food itself ; 
and when we consider how large a part is played in 
our ordinary diet by sugar, starch and fat, the con- 
ception of it as fuel becomes yet more strictly war- 
ranted. 

An important practical conclusion, moreover, fol- 
lows in respect to the quality of our food. Of old, 
when our whole body was supposed to be in a state 
of continual flux, and the main use of food was con- 
ceived to be the laying down of tissue, it was natural 
to look upon flesh as flesh's best repairer. The earlier 
achievements of organic chemistry favored the same 
result, for in all physical exertion great waste of mus- 
cular tissue was supposed to occur, which meat diet 
alone could replace. But, as Dr. Pavy justly says,' 
"the information which has been obtained during the 
last few years has completely revolutionised some of 
the cardinal scientific notions formerly entertained " 
on this subject. It is now ascertained that the most 
active and prolonged muscular exercise causes little 
increase in the excretion of urea, and therefore as 
little loss of nitrogen ; while the capacities of herbiv- 
orous animals and insects find ready parallels in the 
human race. ''The inhabitants of mountainous dis- 

^ Treatise on Food and Dietetics. 1874. ' 



ANIMAL FOOD. 37 

tricts prefer to take fat and sugar as provisions when 
they have arduous journeys to perform (Hermann) ; 
and Dr. Anna Kingsford ' has well shown that a great 
deal of the most vigorous work of the world is done 
by men in whose diet flesh plays little or no part. 

Shall we, then, follow her to her conclusion that 
we should all be vegetarians ? I think not. I quite 
acknowledge that man is essentially a frugivorous 
and graminivorous animal ; and that on fruit, pulse, 
and cereals, with milk and water to drink, he may 
keep himself in health and vigour. But man is some- 
thing more than an animal ; and as he has gone be- 
yond his simian fellows (I will not say ancestors) in 
learning to cook his food, so has he in widening the 
range of his diet. He has done for himself what he 
does for his domestic animals, teaching dogs and cats 
to live on bread and milk, which their wild brothers 
— wolves and tigers — would starve rather than touch. 
The Biblical tradition of permission to eat flesh hav- 
ing first been given to Noah after the Deluge, — 
primitive man having been a vegetarian,^ suggests 
such aliment as an advance on his part, suited to 
change of environment ; and such it assuredly is, 
for in cold and damp climates animal food can rarely 
be dispensed with. Chemistry witnesses to its use- 
fulness, for it shows a certain amount of nitrogen 
as necessary to be supplied in the diet ; and meat gives 
us this in smaller compass than any other food, and 
with greater relish. There is, moreover, a stimulant 

^ The Perfect Way in Diet. Lond., Kegan Paul. 1881. 
2 Genesis ix. 3 ; I. 29. 



38 THE KNOWLEDGE OF HEALTH. 

quality about meat — especially roast meat — which 
no other food can supply. The vegetarians object to 
this, saying that it gives to man some of the ferocity 
of the carnivora. But a slight infusion of their char- 
acteristic nature is possibly not without benefit to the 
human stock, doing for it what the blending of Nor- 
man with Saxon did for the Englishman. 

But while I cannot endorse or practise, in its 
entirety, the vegetarian regimen, I do so far agree 
with its advocates that flesh should be the exception, 
instead of the rule, in human dietary. The three meat 
meals a day, so favoured in my country (I do not 
know how it is with you), are alike wasteful and inju- 
rious. Wasteful, because animal food — fish, flesh, 
or fowl — is the most costly of our aliments ; and 
injurious, because less force can be made out of it in 
proportion to its bulk than out of any other article 
of diet, and the residual substance goes to burden 
the liver with the formation and the kidneys with the 
elimination of urea to an extent quite beyond their 
powers. Hence — unless the most vigorous out-door 
exercise counteract the evil — there comes lithsemia, 
azoturia, and gout, if not organic disease itself. I 
am of course speaking of the lean of meat : the fat 
occupies a different place, and its ingestion need be 
limited only by the powers of digestion. Bacon or 
eggs thus suggest themselves as the most suitable 
adjunct to breakfast, and cheese to lunch or supper, 
where we do not care to make thes-e purely- vegetable 
meals, confining the consumption of lean meat to 
dinner only. 



DRINK. 39 

I would sum up the leading principles of diet 
thus : — 

a. The growing child requires food for the supply 
of substance, and cannot have too much, if he can 
digest it. Milk, oat- and wheat- meal, sugar and fruits 
are his main subsistence until he begins to learn, and 
then meat should be added. 

b. The adult requires a certain small amount of 
nitrogenous food to repair waste, and this he can 
best get in meat. But his main requirement is force 
for work, which can be derived from carbo-hydrates 
and hydro-carbons — starches, sugars and fats — with 
less expenditure than from any other source. The 
Irishman gets these in his potatoes and buttermilk, 
the Hindoo in his rice and ghee ; and either needs 
only a small proportion of meat or pulse to raise him 
to full vigour. 

So far as to what we should eat ; and now as to 
what our drink should be. First of all I would say 
that few people drink enough water. They forget 
that this element constitutes at least two-thirds — 
some say four-fifths — of our frame, so that it is a 
veritable food, especially as no part of us is being 
more constantly given off. Your plucky compatriot, 
Dr. Tanner, lately interested the whole civilised 
world by showing how a man could live for forty 
days on water alone ; and he was only illustrating 
thereby to an unusual degree a recognised scientific 
truth. Water is further a diluent and solvent, and 
as such plays a most important part in the system, 
— all whose processes languish without it. A pure 



40 THE KNOWLEDGE OF HEALTH. 

water-supply is the prime necessity of every habita- 
tion, — not only as excluding germs of disea,se, but 
as encouraging the free imbibition of the fluid. The 
cautions sometimes given against it are mere fancies. 
You are told that you must not drink of the moun- 
tain streams while pedestrianising in Switzerland : I 
have more than once done so copiously with perfect 
impunity. I was warned when I visited your Phila- 
delphia in the *' heated term" of 1876 that I had 
better not make too much use of ice-water ; but I 
should be sorry to say how many gallons my thirsty 
lips disposed of with nothing but refreshment. 

And now what shall we say to the tea, coffee and 
cocoa we drink warm at some of our meals .'' The 
cocoa we may dismiss as little more than a liquid 
food — one, indeed, of the utmost value, but not 
concerning us here. Tea and coffee occupy an iden- 
tical place, save that the latter is a little more heat- 
ing. Both diminish waste of tissue, both stimulate 
the nervous centres. They are therefore admirably 
adapted to circumstances involving much exposure 
or fatigue ; and we can well understand how the 
Arctic voyager prizes them, and what store the Peru- 
vian mountaineer sets on his analogous coca. But, 
per contra, they seem less suitable to normal condi- 
tions and healthy bodies ; and, though we may not 
condemn coffee so strongly as Hahnemann did, or 
anathematise tea with the Dean of Bangor, I think 
there can be no doubt of their frequent abuse. I 
would keep them entirely away from the young ; and 
if adults must use them, would have them ordinarily 



TEA, COFFEE, AND TOBACCO. 4I 

made too weak to produce any appreciable effect, 
increasing strength only according to need. Even 
then we must beware of being lulled to false security 
by their potent action. They check waste of tissue, 
and so far are useful as temporary conservators ; but 
we must remember that the material thus retained 
is partially effete, and that true health lies in its 
removal and replacement. By their gentle stimula- 
tion they take off the sense of fatigue ; but this 
sense is nature's cry for repose, and if it is hushed 
up instead of its appeal being granted, a nemesis 
will sooner or later follow. 

I may here speak of tobacco, which, though not 
taken through the digestive organs, yet behaves in 
the system like tea and coffee, so far as the tissues 
are concerned. It thus partakes of their advantages 
and of the objections to them ; and, like them, should 
be used — if at all — in the strictest moderation. We 
do not drink tea and coffee all day, but so — I fear — 
do many smoke tobacco. If you ask them why they 
thus act, they will tell you that they enjoy the sooth- 
ing effect on the nervous system. Tobacco differs 
indeed from the substances I have just mentioned in 
being a sedative here, not a stimulant. It depresses 
from the first, and its ultimate action is prostration 
and paralysis ; while tea and coffee, carried to excess, 
over-excite. Well : if the brain and nerves are tem- 
porarily disturbed, and want quieting, I would not 
grudge the solace which a pipe can bestow. But 
surely this does not occur to all men every day, and 
several times in a day, as would be inferred from the 



42 THE KNOWLEDGE OF HEALTH. 

practice of most smokers. To induce sedation with- 
out cause is — to speak plainly — a slight self-poison- 
ing ; and those who incur it should realise what they 
are doing. 

Last, of alcohol. I have nothing to say here on 
the moral aspect of ''drinking" — of its peril of in- 
ducing intoxication, which we all agree to condemn. 
Nor would I speak of the usefulness of alcohol as a 
medicine, which we all — or nearly all — agree in ac- 
knowledging. The question is as to its place in 
health. Is it a food ? The advocates of total absti- 
nence maintain the contrary, and base their denial 
on the experiments of Lallemand, Duroy and Perrin, 
which seemed to prove that it is entirely eliminated 
by the emunctories. But they ignore the counter- 
experiments of Anstie and Dupre, which — after 
"some fourteen years of almost unintermittent work" 
— have established the fact that a non-intoxicating 
dose of alcohol is almost entirely consumed within 
the body,' and that within a very short time. Oxi- 
dation is the only conceivable mode of its destruc- 
tion, and this implies the liberation of force, which, 
as it does not appear as heat — alcohol actually lower- 
ing the temperature, must become working energy. 
Alcohol therefore is certainly a force-producing food ; 
and many instances are on record of life being sus- 
tained almost wholly upon it for months and even 
years. It is thus, probably, that it acts as a "stimu- 
lant," for its medicinal influence is quite in the oppo- 
site direction. The earliest manifestation of its in- 

^ See Practitioner^ xiii. 15. 



ALCOHOL. 43 

fluence is flushing of the surface and quickening of 
the heart's action ; precisely parallel to that produced 
by the inhalation of nitrite of amyl, and like that 
associated with diminished arterial tension and fall 
of internal temperature (despite the illusive sense of 
warmth caused by the glow on the skin), and so 
pretty certainly owning a similar causation, viz. : vaso- 
motor paralysis. The further progress of its action 
is to depress the other parts of the nervous system, 
beginning with the centres of speech and motion, 
and ending with those of consciousness. It is also 
an irritant to all tissues with which it comes in con- 
tact, either locally or by absorption ; and shares 
with tea, coffee, and tobacco the power of check- 
ing waste of substance. These undesirable col- 
lateral effects spoil it for a food under ordinary 
circumstances, though it may be made such for 
special times — as during exhausting diseases. A 
healthy man may drink a tumbler of light beer or 
a glass of pure wine at his dinner with impunity. 
But if he take the stronger, fortified wines and malt 
liquors, and the spirits, and in such quantity as to 
feel appreciable effects from them, he is inflicting on 
himself the worst of slow poisoning. He is dimin- 
ishing his resistance to cold and his production of 
nervous energy : he is fretting- stomach, liver, kid- 
neys, brain, into smouldering irritation ; and he is 
storing effete tissue which will break down under the 
least provocation, as seen in brewers' draymen when 
they come into hospital from illness or accident. 
The conclusion must be that the use of alcoholic 



44 THE KNOWLEDGE OF HEALTH. 

drinks in health is a custom more honoured in the 
breach than in the observance. It is, for most peo- 
ple, entirely unnecessary ; and, when practised, should 
be so on the most limited scale. A man should be 
independent of it ; and, that he may be so, should be 
brought up without it. Let the dietary of the young 
be non-alcoholic, if you love them ; and then, as they 
grow up, you may pretty safely leave them to do as 
they like. 

I fear I may have wearied you, ladies and gentle- 
men, with these details, but their introduction was 
my only mode of doing justice to the subject. They 
are not taken merely from books ; but represent the 
matured results of nearly thirty years' study and 
observation of their phenomena. I cannot but in- 
dulge the hope that they may be helpful to my 
younger hearers, in enhancing — for their own bene- 
fit and their patients' — their knowledge of health. 



III. 

THE KNOWLEDGE OF DISEASE. 

The physician is a hygienist, but he is above all 
things a healer. His ''high and sole mission " as 
Hahnemann states at the outset of the Organon " is 
to restore the sick to health — to cure, as we term 
it." In this pursuit he has to deal with disease, as 
the subject of his operations, and with drugs, as the 
chief instruments with which he works. The greater 
part of your medical life, whether as students or as 
practitioners, will have to be spent in acquiring and 
applying the knowledge of these two. It cannot, 
therefore, be without profit that we should spend 
some time in considering what such knowledge 
should be — in what proportion it should deal with 
the phenomena, the laws, and the causes, which we 
have seen to be the elements of all knowing. 

I suppose that all lecturers on the Practice of Phy- 
sic begin the account of particular diseases by de- 
scribing their clinical features. *' Every now and 
then," as my former teacher at King's College — Dr. 
George Budd — used to say, "we meet with" cases 

45 



46 THE KNOWLEDGE OF DISEASE. 

presenting such and such groups of phenomena and 
sensations. He would then give the name by which 
the malady thus constituted is styled, and would pro- 
ceed to relate how it came about, and wherein it 
essentially consisted, so far as these points were 
known. But observe the difference involved in this 
*' so far." The aetiology and pathology of the disease 
were more or less uncertain, and our conception of 
them was liable to vary as new facts came into our 
view. But its clinical features remained. They 
were those which perchance Sydenham, or even Hip- 
pocrates, had described as graphically as any modern 
physician : they, amid all shiftings of conception 
about them, were permanent and sure. 

Now when Hahnemann proposed as the law of 
cure similia similibits cttrenhir, "let likes be treated 
by likes," and had to define the elements of the com- 
parison thus implied, he took these features as the 
disease-basis of his method. Simplicity and certainty 
were his aims in practical medicine. He could not 
conceive that the obstacles to them were insurmount- 
able ; ' and he felt sure — in his profound Theism — 
that "as the wise and beneficent Creator has per- 
mitted those innumerable states of the human body 
differing from health, which we term disease, He 
must at tlie same time have revealed to us a distinct 
mode whereby we may obtain a knowledge of diseases, 
that shall suffice to enable us to employ the remedies 

^ I refer to his essay published in Hufeland's Journal in 1797, entitled " Are 
the Obstacles to Simplicity and Certainty in Practical Medicine insurmount- 
able.'"' (Lesser Writings, p. 358.) 



HAHNEMANN S VIEWS. 47 

capable of subduing them, ... if He did not mean 
to leave His children helpless, or to require of them 
what was beyond their power." This "distinct 
mode " was, he considered, the clinical. He was in- 
deed far from refusing the aid of aetiology, to such 
extent as it was available. In the Organon he points 
out that it is obviously part of the physician's duty 
to ascertain the presence or incidence of any exciting 
causes of disease, that he may remove them now and 
ensure their avoidance in future. It is also desirable, 
according to his teaching, to discover the past causes 
— both predisposing and exciting — of the patient's 
morbid condition, as certain medicines are found spe- 
cially suitable when disease has originated in certain 
ways — Arnica when from injuries, Rhus and Dulca- 
mara when from damp, and so forth. Pathology, 
however, Hahnemann absolutely rejected for thera- 
peutic purposes. It was in his day far more a matter 
of guess-work than it is now ; and was too much of a 
quicksand for a sure foundation to be laid in it. But 
he went farther, and maintained that a knowledge of 
the essential nature of disease was both unattainable 
and useless. His views on this subject are best ex- 
pressed in § 5 and 6 of the fourth edition of the Or- 
ganon. " It may be conceived " he there writes '' that 
every disease implies a change in the interior of the 
human organism. But this change can only be in- 
f erred by the understanding, and that in a dim, mis- 
leading manner, from the morbid signs present. It 
is in itself unknowable, and perhaps in no way with- 
out illusion can the nature of the internal invisible 



48 THE KNOWLEDGE OF DISEASE. 

change be apprehended. The invisible morbid alter- 
ation in the interior, and the outward change of con- 
dition noticeable by our senses (the totality of the 
symptoms), together constitute, to the gaze of the 
Almighty Creator, that which we call disease. But 
the sum of the symptoms is the only side of the mal- 
ady accessible to the physician, the only one observ- 
able by him, and the principal thing which he can 
learn from the patient ajid employ for his benefit." 
The side of disease which pathology , explores was 
thus to Hahnemann its noiLinenon in the strict sense 
of the word, — recognised metaphysically as existent, 
but taken no practical account of ; for all purposes 
but those of thought represented by the phenomena. 
The "totality of the symptoms" is, to the thera- 
peutist, the disease. 

Is this position tenable } Most persons would at 
once answer in the negative ; but they would do so, 
I think, without regard to the end set before us in 
thus limiting our apprehension of disease. If we 
were dealing with it as an object of science, a branch 
of natural history, it is certain that symptomatology 
would be an insufficient basis for our knowledge. 
No one has better shewn this than Liebermeister, 
in his Introduction to the section on Infectious Dis- 
eases in Ziemssen's Cyclopcsdia. The basing unities 
of disease on symptoms gave us such pathological 
entities as hydrops, icterus, apoplexy, and the like ; 
and "from this symptomatic stand-point quotidian 
fever was a different malady from the tertian or the 
quartan form, while on the other hand ascites and 



CLASSIFICATION AND PROGNOSIS. 49 

tympanites were only different forms of the same 
disease." He goes on to argue that the most scien- 
tific — because most real — rule of classification must 
refer to causes, must be aetiological. The quotidian 
and quartan types of fever are one, because they 
both originate from malaria : they are to be differ- 
entiated from pyaemic febrile attacks, though these 
may have a similar rhythm and similar symptoms, 
but are to have grouped with them other malarial 
affections which differ greatly in symptoms, such as 
malarial neuralgia, malarial diarrhoea, malarial ca- 
chexia. " The lightest form of varioloid is regarded 
as essentially identical with the most severe form 
of variola : on the other hand, vaccinia and varicella 
are separated from it. . . . The simplest diarrhoea, 
arising from the poison of Asiatic cholera, is to be 
ascribed to this disease : on the other hand, a very 
severe and deadly cholera morbus is to be marked 
as another malady." 

Nor is it for classification only that such scien- 
tific knowledge of morbid states can be turned to 
account. It avails for prognosis. That we are able 
to distinguish true typhus from other forms of con- 
tinued fever, and that we know its natural history, 
enables us to affirm that if the patient passes the 
nadir of his prostration between the fourteenth and 
seventeenth day, and then displays an upward ten- 
dency, he will pretty certainly recover. It avails for 
the general management of the patient. To recog- 
nise relapsing fever as present leads to a care being 
taken after the first apparent recovery which would 



50 THE KNOWLEDGE OF DISEASE. 

Otherwise be needless, but which here materially 
influences the course of the second paroxysm : it 
also suggests the use of antiseptics during the inter- 
val for the possible prevention of the recurrence, as 
was carried out so successfully by Dr. Dyce Brown 
in Aberdeen/ It avails, again, for estimating the 
influence of treatment. Of old, every chancre which 
disappeared without secondaries supervening went 
to the credit of the mercury that was given, or to 
the demonstration of its needlessness if it had been 
omitted. We now know that the soft chancre — 
which occurs by far the more frequently of the two 
— has no such significance, and is naturally without 
sequelce. 

Now if medicine were an applied science only, it 
would be with such knowledge and its utilisation 
entirely that we should be concerned. But it is the 
merit of homoeopathy that in it medicine assumes its 
true place in being an art — the art of healing. The 
physician is not primarily a cultivator of science : he 
is a craftsman, the practiser of an art, and skill 
rather than knowledge is his qualification. His art, 
indeed, like all others, has its associated sciences. 
Physiology and pathology are to it what chemistry 
is to agriculture, and astronomy to navigation. So 
far as they bring real knowledge, the more versed 
the physician is in them the better for himself and 
for those in whose aid he works. But he was before 
they had their being, and his art should have a life 
of its own independent of the nourishment they 

^ See ^rzV./(3?/r;z. 0/ //(?;«., xxxi. 355. 



DIAGNOSIS. 51 

bring. They must, being progressive, consist largely 
of uncertainties — working hypotheses and imper- 
fect generalisations, destined ere long to be super- 
seded by more authentic conceptions. Medicine 
should not vary with their fluctuations, or hold its 
maxims at the mercy of their support. While grate- 
ful for the aid they bring, it should go on its own 
separate way and fulfil its distinctive mission. The 
method of Hahnemann enables it to do this, by tak- 
ing the clinical aspect of disease as its working 
basis. Pathological knowledge has little to do with 
drug-selection so determined. It has taught us — 
for instance — to recognise enteric fever as specifi- 
cally distinct from typhus, and for many purposes 
this differentiation is highly important. But the 
indications for its homoeopathic remedies were just 
as plain when it was classed merely as " typhus ab- 
dominalis," and were as well given of old by Wolf 
and Trinks as they now are by Jousset and Panelli. 

Again, if our aim be the ascertainment of the 
particular organ affected in a given case, symptoma- 
tology is certainly insufficient. Not, indeed, because 
it is to be distinguished from physical diagnosis, and 
has to do with " rational " signs only. The phe- 
nomena perceivable only by a 'scope or speculum, 
the sounds elicited only by percussion and ausculta- 
tion, are as truly symptoms as is a dilated pupil or 
a wheezing respiration. Not thus, but because to 
ascertain the seat of disease we have to bring in the 
aid of morbid anatomy. This is the science of lesions, 
while clinical medicine takes account of maladies — 



52 THE KNOWLEDGE OF DISEASE. 

which, in the words of Tessier, are " constituted by 
an assemblage of symptoms and lesions undergoing 
a definite evolution." The one speaks of hepatisa- 
tion of the lung, the other of pneumonia ; the one 
of herpes, the other of shingles. Now the lesion — 
save where, as in the last instance, it is on the 
surface — is a thing inferred only, not perceived 
or experienced ; and hence is not strictly included 
within the range of the knowledge of disease re- 
quired by the homoeopathic method, which — again 
to quote Tessier — is one of "positive indications." 
To many minds, accustomed to make physical diag- 
nosis their chief aim as physicians, this is a very 
unacceptable feature of our practice. But let us 
look at the matter dispassionately. What do you 
gain by inferring, from certain signs, that a given 
group of symptoms means the presence of inflamma- 
tion of the air-cells proper, as distinguished from the 
bronchiar mucous membrane or the pleura.'* Some- 
thing, it may be, for prognosis : you know better 
what the patient has to expect, and both he and you 
feel more security from being able to follow the mor- 
bid process as it were with your mind's eye through 
all its stages. In other cases, as where the digestive 
organs are affected, a knowledge of the precise seat 
of the malady aids you in general management : you 
can order such food only to be taken as will give the 
affected portion rest — farinaceous diet where the 
stomach, animal where the duodenum is involved. 
In neither instance, however, have you gained any- 
thing as regards positive treatment, especially if you 



ORGANOPATHY. 53 

are going to conduct this by similar remedies. Your 
medicine must indeed act on the same parts as those 
affected by the disease, and in the same manner. 
But, if it produce a Uke group of symptoms, the 
inference is that it does so. As Hahnemann wrote 
in the Organon (§ 148) — *'A medicinal substance 
which has the power and the tendency to produce 
symptoms the most similar possible to the disease to 
be cured, given in a suitable dose affects those very 
parts and points in the organism hitherto suffering 
from the natural disease." It is from the phenomena 
that, in diagnosis, you infer the noumena : quite as 
surely, in treatment, if drug and disease have the 
same phenomena, it may be concluded that their 
noumena are also identical. You are indeed in this 
way more certain of your aim ; for your diagnosis 
may be wrong, as the autopsy not uncommonly 
proves, but your comparison of symptoms — if intelli- 
gent and painstaking — cannot err of the mark. 
And further, — it must be remembered that our 
object is to select, not a simile only, but the siinil- 
linuim — the medicine whose action on the healthy 
corresponds to the particular case in its individuality, 
in the finer features and more minute ramifications 
of the malady here presented. Identity of lesion is 
insufficient for this: "we want" as Dr. Drysdale 
has said "a pathological simile far more exact and 
qualitatively like than that afforded by mere coarse 
morbid anatomy, which is common to all cases alike." 
We get this by fitting together the variety of phe- 
nomena manifested in disease and in drug-action, by 



54 THE KNOWLEDGE OF DISEASE. 

''covering" the one with the other. We may not 
be able to explain why certain symptoms are present 
in certain cases : but we must believe that each has 
its proximate cause, and that the combination of such 
causes constitutes the individual malady from which 
the patient is suffering, and to which our drug must 
be fitted. 

For drug-therapeutics on the homoeopathic princi- 
ple, therefore, symptomatology may justly supersede 
diagnosis, as being in many cases surer and in all 
more thorough. It gives us this further advantage, 
that it often enables us to attack maladies in their 
forming stage, before they have developed such le- 
sions as physical signs can manifest. The totality of 
symptoms is intended to be a curative indication, and 
if disease is to be cured it should be taken as early 
as possible, before such results have occurred as be- 
come the subjects of morbid anatomy post mortem^ 
or even of pathology during life. In such early stages 
maladies are recognisable by rational signs alone, and 
mainly by symptoms of a subjective nature. This 
point has been forcibly made by Carroll Dunham, in 
his essay entitled ''The Relation of Pathology to 
Therapeutics ; " and I would take the opportunity of 
commending the writings of this "beloved physician" 
(by no name less tender can those who knew him 
speak of him) to your most earnest attention. His 
lucid style is but an index to the clearness of his 
thought ; and in him Hahnemann finds an expositor 
Who knows how to reconcile him to science and ex- 
pound him in reason without sacrificing an iota of 



CARROLL DUNHAM. 55 

his essential principles. In the essay I have men- 
tioned he shews, that as physiology takes cognizance, 
not of life, but of the results of life, so that with 
which pathology is concerned is the result of the 
abnormal and perverted life which we call disease. 
The products of disease pathology sees, hears, or 
infers : it knows nothing of disease itself. Hence, 
to base therapeutics upon pathology alone is to make 
the former merely palliative — a pumping out a leak- 
ing ship instead of stopping the leak. It may be 
said that we do not know where the leak — the pri- 
mary disturbance — is, and that if we knew we could 
not reach it to stop it. But by the proving of medi- 
cines we obtain agents which shew their power to 
cause similar inundations, and therefore, presumably, 
similar breaches, which — upon the principle similia 
similibiLS — it is the hypothesis that they can repair. 
If, then, the comparison between the results of dis- 
ease and of drug-influence be thoroughly and accu- 
rately made, the parallelism of action must reach also 
to that which originates either. ''And here" Dr. 
Dunham writes " I cannot refrain from rendering 
homage to the wonderful prevision of genius by 
which, in an age when pathology, as we understand 
it, was unknown, Samuel Hahnemann anticipated all 
that we have said, and all that the most advanced 
thinkers of our day have taught, respecting the scope 
and influence of Pathology in relation to Therapeu- 
tics. The symptoms of the urinary organs in con- 
nexion with the discharge of morbid urine would at 
one time have been regarded g.s the proper subject 



56 THE KNOWLEDGE OF DISEASE. 

of treatment. But Pathology has now taught us 
to trace these symptoms back to the kidneys, and be- 
yond the kidneys to the blood, and beyond the blood 
to the nutrition and the destruction of all the organ- 
ised tissues. As Dr. Carpenter remarks — 'When, 
for example, the urine presents a particular sediment, 
our enquiries are directed not so much to the sedi- 
ment itself, as to the constitutional state which 
causes an undue amount of the substance in ques- 
tion to be carried off by the urinary excretion, or 
which prevents it from being (as usual) dissolved in 
the fluid.' To confine the attention, therefore, in 
prescribing for a given case, to the immediate organ 
the perversion of whose functions is most obviously 
pointed out by the prominent symptoms, is to disre- 
gard the clearest indications of Pathology. We must 
analyse these obvious symptoms, and must include 
their remotest elements in our indications. Nay, 
these remotest elements — the constitutional disturb- 
ances, for instance, of which Carpenter speaks — are 
even more important indications for treatment than 
the more obvious and objective symptoms. But 
how can we analyse these more obvious symptoms, 
and ascertain those ' constitutional disturbances ' in 
which they have their origin } In no other way than 
by a study of the functions of the entire organism — 
in what way and to what extent they are performed 
in an abnormal manner. And this brings us at once 
to that rule on which Hahnemann so strongly in- 
sisted, that the entire organism of the patient should 
be examined in every possible way, and that the 



THE FEVERS. 5/ 

* totality of symptoms' should be made the basis of 
the prescription ; nay, that the constitutional, gen- 
eral symptoms are often more conclusive as to the 
proper treatment than the more obvious local symp- 
toms. The grand old master reached at a single 
bound the same conclusions to which the labors of 
a half century of able pathologists have at last, with 
infinite research, brought the medical profession." 

All this time we have been dealing with general 
principles ; but let us look at special forms of disease, 
and see whether or no the Hahnemannian mode of 
regarding them is sufficient for their treatment. 

I. T\i^ fevers constitute a group which plays a large 
part in daily practice. They are maladies in which 
morbid increase of temperature exists prior or out of 
proportion to any local inflammation which may be 
present. The theory of this state is still a moot 
one. According to some pathologists it depends upon 
excessive heat-production ; according to others, upon 
deficient heat- radiation ; while yet another class (with 
whom I venture to think the truth resides) believe 
that both factors operate in the process. But what- 
ever be the genesis of fever, it remains a positive 
fact, a clinical entity, with which we have to deal. 
Upon the homoeopathic principle, we have to treat it 
with drugs capable of producing fever. How they 
do so, we may not know ; but our ignorance of the 
process matters little if we are sure about the result. 
*' An infinitesimal quantity of atropia — a mere atom," 
— writes Dr. Harley, " as soon as it enters the 
blood, originates an action which is closely allied to, 



58 THE KNOWLEDGE OF DISEASE. 

if it be not identical with, that which induces the cir- 
culatory and nervous phenomena accompanying ente- 
ric or typhus fever." This is sufficient ; and as soon 
as we learnt it to be a fact, from Hahnemann's prov- 
ings of Belladonna (made, I may add, before Dr. Har- 
ley was heard of), yet minuter quantities of Atropia 
(in the form of the juice of its mother-plant) became 
in our hands trusted remedies for these very fevers. 
Again (for here there is no question of lesions) the 
classification of fevers of which we have already 
spoken, so necessary for science and so valuable for 
general purposes, has but the smallest influence upon 
drug-selection. The old divisions of synocha, syno- 
chus and typhus (the last with its "nervosus" and 
"putridus"), worthless as they are from a scientific 
point of view, are much more useful for our practice 
than those of typhus, typhoid, relapsing and epheme- 
ral. They denote the kind of fever with which we 
have to do, its quality and mode of life ; and to us it 
is all-important that our drugs, next to being really 
febrigenic, should correspond in their action to the 
kind of fever present. They can hardly set up a 
whole typhoid, in its complete evolution ; but the 
febrile state they develope is certainly either a syno- 
cha, a synochus, a typhus nervosus versatilis or stu- 
pidus, or a typhus putridus ; and if we find these 
states existing, in the essential fevers, the exanthe- 
mata, or elsewhere, in them we shall have our reme- 
dial means. 

2. After fevers, the most important group of dis- 
eases consists of the iiiflammations. To the pathology 



THE NEUROSES. 59 

of this morbid process many pages are devoted at the 
commencement of every treatise on medicine or sur- 
gery. Whether, after all that has been said, we 
know much about it in its essence, may well be 
doubted ; but, even if we do, of what avail is our 
knowledge for treatment — at any rate for medicinal 
treatment ? The old phenomenal signs, dolor, calor, 
rtibor, turgor, still for all practical purposes constitute 
inflammation, when externally manifested ; and when 
it is internal, and so invisible, the facts which lead 
us to infer its presence and seat are no less of the 
symptomatic order, as I have already argued. To 
treat inflammation homoeopathically, it is only neces- 
sary to find a drug capable of setting it up, at the 
same spot and in the same manner, as evidenced by 
the symptoms. 

3. The neuroses, of which I would in the third 
place speak, are still — as Liebermeister says — symp- 
tomatic groups. Their unity is one neither of cause 
nor of (known) lesion : it is clinical only. It is of 
much interest to know what is the seat and process 
of the epileptic paroxysm ; but our choice of anti- 
epileptic remedies must be determined mainly by 
the power they have of inducing similar paroxysms 
in the healthy subject, explain it or not as we can. 
In like manner is it with chorea and tetanus and hys- 
teria : no conceivable knowledge we can gain as to 
their intimate nature would make us better able 
to fit homoeopathic remedies to them than we should 
be if we possessed their symptomatic analogues in 
drugs. 



60 THE KNOWLEDGE OF DISEASE. 

It thus appears that, of the three elements we 
have seen to exist in all knowledge — phenomena, 
laws, and causes, it is the first which, for positive 
therapeutic action, chiefly concern us in disease. 
Not that the other two are worthless to us, even for 
this end. Our laws here are classifications — the 
recognition in morbid states of genera, species and 
varieties analogous to those of animated nature. 
These enable us to form groups of remedies asso- 
ciated with them, instead of having to wander 
through the whole Materia Medica for each pre- 
scription : they also give a continuity to medicinal 
treatment, without which the iisiis in morbis were 
of no avail. Hahnemann led the way here, by con- 
stantly insisting on the existence of fixed and defi- 
nite types of disease, to which standing remedies 
should be applied ; and by giving us his group of 
"antipsorics." I fear, however, that he must be 
considered as having rejected all enquiry into causes 
— I mean proximate causes, the noumena of the 
phenomena — in this sphere. In so doing we need 
not follow him. His ground for taking symptoms 
as the element of parallelism between disease and 
drug-action was that they only were surely known. 
In his day this was true, and his selection of them 
was most prudent. But to maintain that they only 
were knowable was unwarrantably to bar the ad- 
vance of science. His stricter followers have acted 
on the dict2uii, and have looked askance on the posi- 
tive pathology of the present day, with its physical 
diagnosis and post-mortem confirmations. They are 



PATHOLOGICAL SIMILARITIES. 6l 

always a decade or more behindhand in their recog- 
nition of such distinctions as those between typhus 
and typhoid, between chancre and chancroid, and in 
their use of such means as auscultation and ther- 
mometry. Now this is altogether wrong. An infer- 
ence from symptoms, if sure, is as good a basis for 
treatment as symptoms themselves. This sureness 
is assumed in the prognosis given and the general 
management instituted : why should it not be also 
for purposes of drug-selection ? By proceeding upon 
it we secure another route to the sivtilc we desider- 
ate. We use symptoms to reach it, because they 
are its most certain expression ; but, if it can be 
otherwise attained, the alternative access may often 
be useful. Morbid lesions sometimes occur almost, 
if not quite, without symptoms, as for instance 
caries of the vertebrae, and senile pneumonia. To 
attempt to "cover" these from the results of the 
proving of drugs would be futile. But toxicology 
and experiments on animals here come to our aid, 
and give us in Phosphorus a substance capable of 
inflaming alike the cancellous structure of bone and 
the pulmonary air-cells ; so that with it we can com- 
bat these diseases, however latent and expression- 
less they may be. There is indeed something 
fascinating about similarities of this kind ; and an 
eminent English homoeopathist. Dr. Sharp, has pro- 
posed (following in the footsteps of Paracelsus and 
Rademacher) to make seat of action instead of 
symptoms the basis of our method, which accord- 
ingly he would call "prganopathy." That remedies 



62 THE KNOWLEDGE OF DISEASE. 

SO led to may prove effectual is undoubted : we have 
a good example of them in the Ceanothus Ameri- 
canus, which, though never proved on the healthy, 
and only known to "act upon" the spleen, has been 
found strikingly effective in enlargements and other 
disorders of this organ. But we should never, if 
possible, rest content with identity of seat betweefl 
disease and drug : we should aim also at making their 
kind of action the same, and this can only be done 
by securing similarity in their symptoms. In this 
way we elevate the siuiile to a siinilliimnny and pro- 
portionately enhance its energy in cure. 

We thus come back to the phenomena as our 
mainstay in practice : for therapeutic purposes, the 
totality of symptoms constitutes the disease. As a 
result of this view, the examination of patients by 
the homoeopathic prescriber is far more minute than 
that ordinarily practised. He can hardly, indeed, 
inspect and explore for himself more thoroughly 
than does the well-trained practitioner of to-day ; 
but he listens to and questions the sick person with 
greater patience and more painstaking complete- 
ness. His object is not merely to find out to what 
recognised malady his patient's troubles are to be 
ascribed : for such end but few symptoms are neces- 
sary, and the rest can be left. He has to get at 
their totality, that he may cover them with a medi- 
cine capable of producing them on the healthy sub- 
ject ; and in pursuit of this aim he must not account 
any detail superfluous. It has been objected that we 
should come off badly upon such a method with Mrs. 



SUBJECTIVE SYMPTOMS. 6^ 

Nickleby for a patient. But happily Mrs. Nicklebys 
are exceptions ; and when we do meet them common 
sense must deal with them accordingly. Of course, 
proportion must be observed; and any thing we 
k/ioza to be merely incidental may be omitted. Our 
colours must be mixed, like Opie's, " with brains, 
Sir." But if we only //ihi^ a detail unimportant, 
our wisdom will be to give the patient the benefit 
of the doubt, and insert it in our picture. 

In this way we are led to that greater regard for 
subjective symptoms in favour of which Dr. Russell 
Reynolds so eloquently pleaded before the British 
Medical Association in 1874. 

" Is it not coming to this " he protested " that but little atten- 
tion is often paid to the accounts which patients give of them- 
selves, their ideas, emotions, feelings, and physical sensations? 
These are things which we cannot weigh in our most guarded 
balances ; measure by our finest scales ; split up by our cruci- 
bles ; or describe in any terms save those which are peculiar to 
themselves, and which we cannot decompose. These symptoms 
are often disregarded and set aside ; and the patient, whose story 
of disease is made of them, is thought fanciful, hypochondriacal, 
hysterical, nervous, or unreal ; because, forsooth, we have physi- 
cally examined thorax, abdomen, limbs, and excretions, and have 
found in them nothino- wrong; because we have looked at the 
retinae, examined the limbs electrically, traced on paper the 
beatings of the pulse, weighed the patient and not found him 
wanting. Still he is miserable, in spite of placebo and assurance 
that there is nothing organically wrong! There may be in him 
a consciousness of a deep unrest ; or of a failing power, which 
he feels, but which we cannot see ; or of a something worse 
than pain, a sense of impending evil, that he is conscious of in 
brain or heart; a want of the feeling of intellectual grasp, which 



64 THE KNOWLEDGE OF DISEASE. 

he may call failure of memory, but which memory ^- when we 
test it — seems free from fault; a want of the sense of capacity 
for physical exertion, which seems, when we see him walk or 
run, to be a mere delusive notion, for he can do either well or 
easily to our eyes and those of others ; and so he is called ner- 
vous, and told to do this or that, and disregard these warnings 
which come to him from the very centre of his life. And let 
me ask whether or no it has not again and again happened in 
the course of such a history as that which I have only faintly 
sketched, that some terrible catastrophe has occurred ? Do we 
not see minds gradually breaking down while we say there is 
no organic change in the brain? hearts suddenl}' ceasing to do 
their work, when after careful auscultation we have said there 
was nought to fear? Suicide or sudden death sometimes dis- 
turbs the calm surface of our scientific prognosis of no evil: 
we may be startled, and may then see all that we ought to have 
seen before. But when the ripples that such unforeseen events 
have occasioned on that smooth surface have subsided, we go 
on as we have already done, and still pay but little attention to 
what the patient feels, and delight ourselves in the precision of 
our knowledge with regard to physical conditions of which he 
may know nothing and may care still less. No one can appreci- 
ate more highly than I do the value of precise observation, but 
I do not believe that minute, delicate, and precise observation is 
limited to a class of facts which can be counted, measured, or 
weighed. No one can see more distinctly than I do the wrong 
conclusions at which a physician may arrive by accepting as 
true the interpretations which fanciful patients may offer of their 
symptoms ; but I am sure, that if we pay no heed to these mis- 
taken notions of a suffering man, we lose our clue to the com- 
prehension of the real nature of his malady. Morbid sensations 
and wrong notions are integral parts of the disease we have to 
study as a whole, and we are bound to interpret their value for 
ourselves; but we can ill afford to set them aside, when we are 
as yet but in the dawn of scientific pathology, and are endeav- 
ouring to clear away the obstacles that hide the truths we hope 
hereafter to see more clearly about the m}stery of disordered 



THE TOTALITY OF SYMPTOMS. 65 

life. The value of such SA-mptoms may be slight in some kinds 
of disease, when compared with that of those phenomena which 
may be directly observed ; but we are bound to remember that 
there are many affections of which they furnish the earliest indi- 
cation, and there are not a few of which they are throughout the 
only signs." 

In the light of this, which is but one among the 
many advantages of Hahnemann's mode of observ- 
ing disease, I think we may make claim for it as be- 
ing, not only the one safe thing for his own time, 
but also a mode of procedure most important in 
itself, and never to be left behind. It needs espe- 
cially to be emphasised at the present day. It is 
with us as before the Reformation, when the Bible 
was used by the Church only as a rule of faith — a 
source whence were to be inferred the doctrines and 
practices obligatory on her children. What Luther 
and his fellows did was — as Dr. Robertson Smith 
has well shewn — to recover the Book itself, in the 
totality of its thoughts and words, as a means of 
grace to each individual soul. The fruitful results 
thus achieved in the spiritual sphere will be par- 
alleled in the medical as the clinical study of disease 
is allowed its due preponderance, and is made the 
direct road to therapeutics. Of this reformation 
Hahnemann was the preacher in his day ; and his 
voice must ever be echoed by his disciples when they 
see the profession straying into the alluring, but less 
practical, by-paths of pathological speculation. 

In support of thus acting, they can now cite the 
words of another acknowledged leader in English 



66 THE KNOWLEDGE OF DISEASE. 

medicine, Sir Andrew Clark. In his Presidential 
Address at the Clinical Society of London in 1883, 
this distinguished physician said : ^ — 

"Another great work of our Society has been, and continues 
to be, the gradual unfolding of the exact relations which morbid 
anatomy and, incidentally, experimental pathology should hold 
to clinical medicine. These two chief servants of our art, 
excited and carried away by their marvellous successes, and 
assuming a joint sovereignty over our art, look down with conde- 
scending superiority upon clinical medicine, ridicule her claims 
to supremacy, scoff at her empirical distinctions, reproach her 
with being unscientific, and strive to torture her into a slavish 
subjection to their theories. But the true relation is not this ; 
it is, indeed, the converse of it. For the structural change is not 
disease, it is not co-extensive with disease ; and even in those 
cases where the alhance appears the closest, the statical or 
anatomical alteration is but one of other effects of physiological 
forces, which, acting under unphysiological conditions, consti- 
tute by this new departure the essential and true disease. For 
disease in its primary condition and intimate nature is in strict 
language dynamic ; it precedes, underlies, evolves, determines, 
embraces, transcends, and rules the anatomical state. It may 
consist of mere changes in the relations of parts, of re-arrange- 
ments of atomic groupings, of recurring cycles of vicious chemi- 
cal substitutions and exchanges, of new conditions in the evolu- 
tion and distribution of nerve force, and any or all of them may 
be invisible to the eye, inseparable from life, and undiscernible 
in death. Undoubtedly the appearance of a structural alteration 
in the course of disease introduces a new order of events, sets in 
action new combinations of forces, and creates disturbances 
which must be reckoned with, even as mechanical accidents of 
the pathological processes. But always behind the statical lies 
the dynamic condition; underneath the structural forms are the 
active changes which give them birth, and stretching far beyond 

^ Lancet, Feb. 3, 1883. . 



SUPREMACY OF CLINICAL MEDICINE. 6/ 

the limits of pathological anatomy, and pervaded by the actions 
and interactions of multitudinous forces, there is a region teem- 
ing with manifold forms of disease unconnected with structura4 
change and demanding the investigation which it would abun- 
dantly reward. It is in this mysterious and fertile region of 
dynamic pathogenesis that we come face to face with the primi- 
tive manifestations of chsease, and learn how much knowledge 
from various sources is needed to understand it aright ; it is 
here that we see how, without help from physics, chemistry, and 
biology, collecting, converging, and meeting in a common light, 
no single problem in disease can be completely solved ; it is 
here that we are made to comprehend how the nature of a path- 
ological product cannot be determined by its structural char- 
acter, but by the hfe-history of the processes of which it is only 
a partial expression ; it is here that we observe how, in thera- 
peutic experiments, the laws of the race are conditioned and 
even traversed by the laws of the individual ; and it is here 
that we discover how clinical medicine is to become a science, 
and how she is already, beyond question, at once the mother 
and the mistress of all the medical arts." 



IV. 

THE KNOWLEDGE OF MEDICINES. 

At our last meeting we spoke of the knowledge of 
disease. We saw that the phenomena we call " clin- 
ical " — the symptoms of maladies, subjective and 
objective, rational and physical, in their connexion, 
conditions, and order of evolution — form the most 
important object of our study. They do more than 
enable nosology to classify their sum and pathology 
to diagnose their seat : they directly avail, under the 
guidance of the method of Hahnemann, for the choice 
of their remedies. Nosology aids in this, by group- 
ing drugs around definite morbid species, and pathol- 
ogy by utilising their local affinities ; but both need 
completing by symptomatology to determine finally 
the one medicine which shall be the simillimiLin of the 
disorder we have to treat. We heard some of 
the ripest medical thinkers of our time bearing wit- 
ness indirectly to the validity of this mode of pro- 
cedure, recognising the dynamic origin of disease, 
the importance of subjective symptoms as indicating 
its beginnings, and the necessity of taking all symp- 
toms into account if we are to arrive at a true con- 

68 



FOODS AND MEDICINES. 69 

ception of a case. The inference is that to the clini- 
cal study of disease, as made possible by hospital and 
dispensary, you should devote your chief attention. 
Learn, indeed, all that pathology, which is the science 
of disease, can tell you about it in its various forms ; 
but use the light of such knowledge, not so much to 
gaze upon in scientific interest, as to illumine your 
perception of the actual features of that with which 
you have to do. 

Our subject to-day is the knowledge of medicines, 
which are the tools of the healing art, as disease is 
the material on which it works. What are medicines ? 
I do not know that any better definition of them can 
be given than that which was put forth by Hahne- 
mann in 1805, ^^ the preface to his Fragmenta de 
viribiLS incdicamcntormn positivis : — '' Quae corpus 
mere nutriunt, Aliuicjita, qua^ vero sanum hominis 
statum ( vel parva quantitate ingesta ) in aegrotum — 
ideoque et aegrotum in sanum — mutare valent, Medi- 
caviciita appellant ur." My only difference with him 
would be that I should place the corollary foremost, 
and define a medicine as a substance which has the 
power of changing sickness into health, and there- 
fore — on the principle nil prodcst quod, non Iceditur 
idem — of altering health to sickness. 

Now on what ground is any substance to be reck- 
oned a medicine } and how is it to be ascertained 
what are the morbid conditions and processes it can 
favourably modify } There are but two ways by which 
to arrive at such conclusions, the empirical and the 
rational. 



70 THE KNOWLEDGE OF MEDICINES. 

I. Many, perhaps most, of the ordinary remedial 
uses of drugs have been stumbled upon by chance. 
It has generally been "the common man" (as Hah- 
nemann calls him ), sometimes even the still lower 
brute, that has discovered them ; and the professional 
healer has taken the hint and adopted the practice. 
After this manner has been gained bark as a remedy 
for ague, burnt sponge for goitre, arnica for the effects 
of falls and strains, graphites for tetters, sulphur for 
the itch. Nor less empirically, though among the 
practitioners of medicine, has arisen the use of mer- 
cury and iodide of potassium in syphilis, of bismuth 
in gastralgia, of arsenic in psoriasis. Theories of the 
modus operandi of such remedies have often been 
subsequently framed; but it is certain that their ori- 
ginal adoption grew out of no such theories, but was 
an accidental discovery. 

Now it would be the height of unwisdom to neglect 
information from this source. A remedy is a remedy, 
however come at, and whether conforming or not to 
any laws of action we may suppose to prevail. Ex- 
perience is the test even of medicines rationally ascer- 
tained to be such : it is but beginning the process a lit- 
tle lower down when experience itself discovers them. 
But on the other hand it is obvious that the empir- 
ical method is a very uncertain one, and affords no 
guarantee of further additions to our remedial wealth. 
Indeed it is no method at all, but mere guess-work 
and chance picking-up. It is only hopelessness as 
to rational therapeutics which can lead writers like 
Wilks and Druitt to make empiricism a matter for 
satisfaction and a standard of advance. 



RATIONAL MEDICINE-SEEKING. *J\ 

2. There are certain pseudo-rational modes of dis- 
covering remedies which have brought undeserved 
sHght on those truly bearing the name. Such are 
the doctrine of " signatures " and much of the iatro- 
mechanical and iatro-chemical theory of former and 
later times. When a real medicine has been gained 
by these means — as chelidonium in disorders of the 
liver and euphrasia in those of the eye, as iron in 
anaemia and muriatic acid for low fevers — it has been 
by coincidence, not from induction : the result is 
practically empirical. The truly rational method is 
that which infers the place and power of a drug in 
disease from its behaviour in health. Every such 
substance, on being introduced into the animal organ- 
ism, causes certain disturbances, certain changes. 
Each has its proper series of effects : each selects 
certain organs and tissues, or certain tracts and re- 
gions, of the body, and there sets up phenomena of 
a definite kind. This is the only source of informa- 
tion which is surely and indefinitely fruitful. If from 
observing the pathogenetic effects of a substance we 
can conclude (subject to the teachings of experience) 
as to its therapeutic virtues, we have but to experi- 
ment with fresh poisons in order to gain as many 
additional remedies. 

It is (as you know) the glory of Hahnemann that 
he perceived the supreme value of this mode of dis- 
covering medicines, that he earnestly preached and 
diligently practised it. By so doing, and by discov- 
ering — in similia similibus — the link between path- 
ogenetics and therapeutics in the latter's highest 



72 THE KNOWLEDGE OF MEDICINES. 

form, he opened the way on which we are now ad- 
vancing, and made possible every triumph we can 
obtain. I am not relating to you the history, or 
vindicating to you the truth, of Homoeopathy ; I 
assume that you know the one and recognise the 
other, and therefore I assume your concurrence with 
me in the proposition that our knowledge of drugs 
must be largely concerned with their physiological 
action. Their effects on the healthy body form the 
parallel to the phenomena of disease : here, as there, 
we must know these phenomena themselves, and 
what we can of their laws and causes. 

And here again the phenomena, in their totality, 
are those which claim our most earnest attention. 
The clinical study of disease must have its comple- 
ment in the acquaintance we make with medicines. 
The law of similars teaches us this, for to obey it we 
must have wholes to compare with wholes. In the 
ordinary practice men aim at knowing what drugs 
can do, that in disease they may induce such effects 
with them, when they judge it desirable. In old days, 
accordingly, they cared only to learn whether a given 
one could purge, or puke, or sweat, that they might 
class it as cathartic, emetic, or sudorific ; and now 
they correspondingly limit their investigations to the 
question whether it is an excitant or depressant of 
certain nerve-tracts. For such purposes dumb crea- 
tures suffice ; and hecatombs of these unfortunates 
are now annually sacrificed in enquiries as to drug- 
action. The differences of result, and therefore of 
opinion, are endless ; and the gain is proportionately 



HOMCEOPATHIC PROVINGS. 73 

small. We, on the other hand, have wanted the 
whole picture of the effects of drugs for comparison 
with the phenomena of disease, and have gone to 
work accordingly. As it is human disease to which 
we need siinilia, and as this is largely made up of 
subjective symptoms, it is on the human subject that 
we experiment ; and we faithfully record the whole 
series of morbid changes which occur after the in- 
gestion of a drug. We test the effect of single full 
doses, to get analogues of acute disease ; and of long- 
continued small ones, that chronic maladies may find 
their antitypes. Thus our pathogenetic knowledge, 
when truly obtained and registered, is like a picture- 
gallery, in which the discerning eye may perceive 
the lineaments of all morbid conditions known or 
likely to occur. Our provings minister to medicine 
as an art : they are synthetic and sensuous, full of 
colour and detail. Those of the other camp are 
rather analytic, appealing, to the reason ; and are 
available only so far as morbid processes are scientifi- 
cally understood. The record of the one recalls the 
graphic pictures of Hippocrates and Sydenham and 
Watson, to whose ever-fresh lineaments the mind 
returns with pleasure, wearied with the merely intel- 
lectual refinements of modern nosography. The work 
of the physiological laboratory goes hand in hand 
with that of the dead-house : the Hahnemannic phar- 
macology and pathology alike move in the region of 
life. 

This is the first truth about the matter. To read 
a good proving in detail — like the Austrian of 



74 THE KNOWLEDGE OF MEDICINES. 

Aconite — is like going through a series of clinical 
cases illustrative of the varieties of a particular dis- 
ease. But this comparison of itself suggests that a 
further step is necessary. In recording such cases, 
a physician would do so by way of basis for a discus- 
sion of the disease in question, of its causes, its 
nature, and its treatment. For ourselves too we 
have seen that the clinical aspect is not the only one 
in which we should regard the ills to which flesh is 
heir. From pathology — the science of disease — 
its phenomena are always illuminated, and some- 
times even rendered transparent so that through 
them we can see the noumena. Pharmacology 
should seek a stand-point no less advanced. Prov- 
ings correspond with our studies at the bedside or 
in the prescribing room ; but as to interpret these 
we go to the dead-house, so to the study of prov- 
ings we must add — when possible — that of poi- 
sonings and of experiments on animals, that the 
lesions wrought by drugs may be positively ascer- 
tained. But yet our work is not done. We must 
use these facts also as materials for inductive gener- 
alisation ; we must seek to connect, classify, and 
interpret them, to ascertain their laws, to trace them 
to their causes. In proportion as we do so, we make 
our pharmacology a worthy mate for the pathology 
which is growing into maturity beside it. In neither 
do we content ourselves with generalisations alone : 
the clinical history of diseases and the detailed prov- 
ings of drugs must ever form the basis of our knowl- 
edge, be the superstructure what it may. But while 



PHYSIOLOGICAL INTERPRETATION. 75 

(to employ another figure) these constitute our text, 
we should read it with the help of a commentary 
which may illuminate it by the best available lights. 
There are some who think they are best following 
Hahnemann by shutting their eyes and ears to all 
that has been learned since his time ; by recognising 
nothing in disease but the patient's sensations and 
obvious appearances, and nothing in drug-action but 
a scattered heap of symptoms of like kind. We 
should not go to the other extreme, and ignore any 
aid which may thus be gamed in practice. But we 
should regard the human body, whether idiopathi- 
cally or medicinally disordered, as one of whose 
order we are not wholly ignorant — as a sphere in 
which we are to some degree at home, and where 
we may speak and act as no mere strangers. In 
studying the Materia Medica we are to be more 
than symptom-memorisers, in applying it more than 
symptom-coverers. We are cicri and not laid here, 
and we fall short of our vantage-ground if we work 
mechanically only. 

Let me illustrate. Dr. Jousset, in his recently- 
published Traitc dc la Matierc Mcdicalc, describes 
the action of Digitalis on the heart. He tells us that 
in the form of poisoning he calls foiidroyante, the 
pulse is small, uncountable, sometimes completely 
absent, and the heart-beats precipitate and hardly 
perceptible, with irregularity as recovery ensues ; 
that in the less severe variety he designates progres- 
sive the pulse is at first strong and hurried without 
irregularity, beating 120 to 140 in a minute; and 



']6 THE KNOWLEDGE OF MEDICINES. 

that when the effect is less pernicious, this rapidity 
is succeeded by slowness, which from small doses 
occurs at once. Again, in summing-up this part of 
the drug's action, he states that strong doses ** par- 
alyse the heart and the arteries after hav'ng excited 
them," while still larger doses paralyse from the first ; 
and that, of feeble doses, '^ strong and retarded car- 
diac impulse is the primitive, feeble and accelerated 
the secondary, effect." All this is true and useful 
enough, but what does it mean } The heart is a hol- 
low muscle, contracting rhythmically under the influ- 
ence of the ganglia embedded in its substance, and 
regulated by the opposing influences of the pneu- 
mogastric and sympathetic fibres coming to it from 
the central nervous system. What is meant by its 
being ''paralysed".^ Is it the cardiac muscle itself 
that is incapable of responding to the nervous im- 
pulses, or the nervous centres which have no power 
to send forth their commands } Is the alteration of 
the heart's pulsation due to inhibitory or accelerat- 
ing influences transmitted to it from above, or to 
some change in the organ itself } These are ques- 
tions of no mere speculative interest : on their 
decision depends our view of the use of the drug as 
a remedy. If it paralyses the cardiac nerves only, 
it cannot strengthen and tone up a dilated ventricle 
by its homoeopathic action. If it retards the heart 
otherwise than through the vagi, slow pulse is no 
indication for it when induced by their inhibitory 
influence. Traube has actually ascertained that 
they are the channels through which Digitalis re- 



THE USUS IN MORBIS. JJ 

tards- the heart, and Claude Bernard found the drug 
to be a direct muscle-poison. That the student 
should know this gives him a precious clue through 
the mazes of the phenomena displayed, and shews 
him where the drug is truly homoeopathic, i.e. where 
the pulse is simply slow, or where the cardiac muscle 
is of feeble vitality. 

The physiological effects of drugs, with their in- 
terpretation, form thus the chief material of that 
knowledge of medicines about which we are enquir- 
ing to-day. But there is another and only less im- 
portant field to be worked : I refer to the nsiis in- 
morbis, the therapeutic experience gained with the 
substances we employ in practice. I have already 
urged that a medicine — vicdicaincntnni — is one 
which has shewn its power medicare, to heal : it 
would be such did we know nothing of its power to 
hurt. And conversely, though the pathogenetic 
effects of a drug, when ascertained, are our most 
trustworthy source for eliciting its curative powers, 
they are not necessarily conterminous with these. 
They may fall short of them, through inadequacy of 
provings and absence of poisonings ; or they may 
outrun them, from the multitude of trivial sensa- 
tions the drug may elicit without definite character 
or localisation. Of the former alternative we have 
an instance in Hamamelis : how slight is its patho- 
genesis compared with the frequent use we make of 
it ! For the latter we have examples ready to hand 
in Ptelea trifoliata, in Fagopyrum esculentum, and 
in one of the few provings we in England have 



78 THE KNOWLEDGE OF MEDICINES. 

achieved — that of Cotyledon umbiHcus. These drugs 
have been freely and fully submitted to experi- 
ment : their pathogeneses in Allen's Encyclopcedia 
contain 965, 836, and 253 symptoms respectively: 
but who uses them — at any rate the two last — in 
practice ? The therapeutic virtues of a drug must 
therefore be studied on their own merits ; and, when 
they are of very definite character or on any thing 
like an extensive scale, had best (I think) be taken 
first. The pathogenetic effects can follow ; and these 
will throw light on the clinical results which have 
been obtained, will give them precision and not 
uncommonly expansion. 

I need not say that in so doing you will avoid the 
vicious practice of the old-school writers on Materia 
Medica, who as a rule carefully abstain from connect- 
ing the physiological and therapeutic actions of the 
drugs they treat of. Of old, I imagine, they did this 
from indifference and scepticism (which last Stille 
has plainly avowed) : but now the utmost charity 
cannot acquit writers like Ringer, Phillips and Bar- 
tholow of deliberately adopting this course that the 
frequent testimony their practice bears to homoeop- 
athy may not appear. You, of course, will hail such 
testimony rather than shut your eyes to it. But 
let me urge you not in your turn to be lacking in 
candour when the evidence points the other way. 
This caution is not needless. Here is a patient in 
the agonies of angina pectoris. His heart is as it 
were compressed, his breathing almost impossible : 
his face is deadly pale, his surface cold, his pulse 



ANTIPATHY. 79 

small and contracted. Your old-school colleague 
steps forward, and, taught by Dr. Lauder Brunton, 
applies to his nostrils a few drops of the nitrite of 
amyl. In less than a minute his face begins to flush, 
he warms up, he breathes freely, and the intolerable 
breast-pang is gone. This is beautiful practice : but 
is it homoeopathy ? Nay : for let a healthy man 
inspire the same substance, and the effect will be, 
not the pallor and coldness and constriction, but the 
flush — the dilatation of the imprisoned arteries — 
which delivered the sufferer. In all common sense 
and justice, therefore, this action ouo-ht to be as- 
cribed to the second of those three vwdi operandi 
of medicines described by Hahnemann : it is enan- 
tiopathic, antipathic, affording all the speedy palli- 
ation characteristic of such remedies while open to 
all their disqualifications and reproaches. I have 
nevertheless been grieved to see more than one 
communication to our journals which, on the strength 
of some incidental phenomena in disease and drug, 
have claimed the action of amyl in angina for the 
law of similars. My colleague Dr. E. M. Hale would 
go farther still; and by his theory of ''secondary 
homoeopathicity " would catch every application of 
the physiological action of drugs in the Hahne- 
mannic net. I admire his enthusiasm ; but I deplore 
the effects of such teaching. It leads, I fear, to a 
great deal of very eclectic practice; and it lays us 
open to just retaliation on the part of owx confreres of 
the other camp. We say to them, — you are taking 
our similar remedies, small dose and all, and refusing 



80 . THE KNOWLEDGE OF MEDICINES. 

to acknowledge the law under which they act, using 
them empirically, or explaining away their apparent 
homoeopathicity. They will say in return, — you are 
taking our contrary remedies, full dose and all, under 
a plea which to us at least is transparently futile : 
and I do not see how we can repel the allegation. 

You will not hesitate, therefore, to give credit to 
anti-pathy when you meet with it ; nor will you 
ignore any other curative applications of drugs be- 
cause they seem to lie outside the homoeopathic 
method. Whether you should Employ them must 
depend upon other considerations, which you will 
learn from your teachers : just now, however, this is 
not a practical question for you. Putting these 
aside, you will find in your therapeutic studies of 
medicines abundant examples of true homoeopathic 
action, and will enrich your knowledge of them 
accordingly. You will also learn here another thing 
which pathogenesy alone could not teach you : I 
refer to what are known as the " characteristic symp- 
toms " of our remedies. A great deal too much has 
indeed been made of these features : conditions have 
been dealt with independent of the things condi- 
tioned ; adjectives have been treated as more impor- 
tant than their substantives ; and, so long as disease 
and drug strike the same "key-note," it has been reck- 
oned indifferent whether or not they play the same 
tune, — with what results in discord it is not difficult 
to imagine. But, on the other hand, given your sub- 
stantive, an adjective peculiarly belonging to it is 
often of value in suggesting it and — in case of need 



CHARACTERISTIC SYMPTOMS. 8l 

— distinguishing it from others of its kind. Hahne- 
mann initiated such characteristics when he recom- 
mended Aconite to be given in inflammations when 
"with thirst and rapid pulse, an anxious impatience, 
an unappeasable restlessness and an agonised tossing 
about are conjoined." Experience has abundantly 
confirmed the indication : Dr. Dunham lias shewn 
its coherence with the pathological condition to 
which the drug is suitable, and Dr. Guernsey has 
under its guidance extended the range of Aconite 
into regions which might otherwise have seemed 
foreign to it. The aggravation of Bryonia pains by 
motion and those of Rhus in rest ; the early morn- 
ing waking of the Nux vomica patient, the evening 
exacerbation of Pulsatilla sufferings, the intolerable- 
ness of those of Chamomilla — these are other well- 
known and well-tried characteristics which we owe 
to the master. Later experience has added others 
quite as trustworthy — the aggravations of Rhus 
symptoms on change to wet weather, of Rhododen- 
dron symptoms at the approach of storms, of Lache- 
sis symptoms after sleep ; the relief of the Coffea 
toothache by cold water held in the mouth, the 
nausea of Golchicum at the smell of food, the sensi- 
tiveness of the Hepar patient, and so forth. Dr. 
Claude has lately shewn us, by a series of well- 
selected cases, how important an indication is what 
he calls the rhythm of medicines, — as the tendency 
of Lycopodium attacks to supervene from 4 to 8 
P.M. and of those of Belladonna to come on somewhat 
later. Dr. Hawkes (of Chicago) has in like manner 



82 THE KNOWLEDGE OF MEDICINES. 

illustrated the unfailing way in which a certain group 
of symptoms — vertex headaches, with heat there, 
burning in the soles of the feet in bed, hot flushes, 
and ''gone, empty feeling" about an hour before the 
midday meal — characterises a patient in whose ail- 
ments Sulphur will be beneficial. I might continue 
such an enumeration ad infinitum ; but the point I 
desire to make is that all — or nearly all — this 
knowledge is gained from the nsns in inorbis, and 
would not be learned from a study of pathogenesy 
alone. You must therefore cultivate this field as- 
siduously if you would fill in the outline of your 
acquaintance with the medicines you are to use. 

So far I have been speaking as if disease and 
drug-action constituted a precisely parallel series of 
phenomena. There is an important difference be- 
tween them, however, which perhaps has already 
occurred to your minds. Disease is ever with us. 
Though it is not exactly producible at will, its origi- 
nating germs, or its predisposing and exciting causes 
of a general character, are so widely diffused, that 
no one need go through his student days without 
having seen one or more cases of at least its ordinary 
forms. In exhorting you therefore to study disease 
clinically, with pathology as the lamp to illuminate 
the field, an intelligible and practicable task is being 
assigned. With drug-disease it is otherwise. This 
is to some extent producible at will, but the will is 
(naturally) lacking ; and we can only study it in the 
records left us by those who have been — voluntarily 
or involuntarily — the subjects of medicinal action. 



RECORDS OF DRUG DISEASE. 8^ 

This is a serious drawback ; and the only compensa- 
tion for it would be that the records in question were 
as full and clear and life-like as possible. Suppose 
the student were debarred from studying disease at 
the bedside or in the dispensary. He would value the 
more the teachings from the chair of the Theory 
and Practice of Physic ; but he would feel that, after 
all, what he got there introduced him to maladies 
only in their typical, somewhat abstract and ideal, 
forms. He would crave for lectures and books con- 
taining detailed narratives of cases, so selected as to 
illustrate the various forms and varieties in which 
disease is liable to occur. But suppose that, instead 
of such material, a volume (or ten volumes) were 
put into his hands in which, under the head of each 
malady, there was given a list of all the symptoms 
which had been observed in the several instances of 
its occurrence, — these being divorced from their 
connexion and sequence, and re-arranged under the 
headings of the part or function of the body to which 
they seemed to belong. Would he not reject with 
loathing this stone offered him instead of bread ? 
would he not clamour for the clinical records, fresh 
from nature's mint, of which some cruel technicality 
had gone out of its way to deprive him ? 

You will have anticipated me in feeling that this 
is the unhappy position in which you are actually 
placed in respect of the Materia Medica. I know 
your teacher of that subject too well to doubt that 
he gives you, in the most instructive way, all the 
information regarding it which is communicable in 



84 THE KNOWLEDGE OF MEDICINES. 

lectures. But, after all, he has only introduced the 
medicines to you : he has done for their pathogenesy 
what the Professor of ''Theory and Practice " does for 
disease. Where, then — as you cannot study drug- 
maladies in life — are the clinical cases, the detailed 
provings and poisonings of individuals ? They mostly 
exist, — though Hahnemann is said to have been un- 
kind enough to destroy the day-books of his provers : 
they exist, — but scattered through interminable vol- 
umes, often sealed up in a foreign tongue, sometimes 
still only in manuscript. The writer of a monograph 
on any drug has the utmost difficulty in getting to- 
gether all the necessary materials, as a certain Club 
in this city found when they began the labours 
which resulted in their charming little volume on 
Gelsemium : ' but what is the student of all drugs 
to do ? He may make the most of such books as 
those of Hempel and Burt, or as that Manual of 
Phannacodynamics of my own which the authorities 
of this school have honoured me by admitting among 
their text-books. But these, after all, occupy only 
the same ground as the lectures he hears, and must 
be read in connexion therewith. Both one and the 
other are introductions : but what is it to which you 
are introduced t Whether in Hahnemann himself, 
in Allen, or in Hering, it is that unhappy jumble of 
symptoms whose inadequacy to instruct has been 
already seen in the parallel instance of disease. 
What, then, are you to do } As matters stand at 

^ Gelsemhtm sempcrvirens. A monograph by the Hiiglies Medical Club 
of Massachusetts. Boston : Otis Clapp and Son. 



THE SCHEMA FOR REFERENCE ONLY. 85 

present I would advise you, for all a priori knowl- 
edge of medicines, to content yourselves with the 
general view given in your lectures and text-books, 
with the broad features of their physiological action 
eked out with the fullest possible acquaintance with 
what they have done and are likely to do in the 
way of therapeutics. Their minute symptomatology 
it is hopeless to memorise, but no less perilous to 
abridge : let it stand as it is, with such discrimina- 
tion as you can supply, and use it a posteriori only. 
Whenever an unusual symptom or combination of 
symptoms meets you, whenever a case "hangs fire" 
under the ordinary remedies, hunt up the phenomena 
by means of a repertory, which is just an index to 
the Materia Medica. If you find them there, if their 
source (so far as known) is trustworthy, if the drug 
to which they are ascribed is otherwise suitable to 
the case, give it, nothing doubting. You will some- 
times miss your mark, but quite as often you will hit 
it ; and in this way you will turn to profit a symp- 
tomatology which otherwise is only a barren and 
trackless wilderness. 

I believe it would be a great deliverance to the 
student, and also to the would-be convert, of homoe- 
opathy if it were distinctly understood that our 
symptomen-codices were not meant to be studied. 
The endeavour so to use them has turned back many 
an enquirer in disgust : as it is said to be ominous 
that our English Marriage Service begins with 
" Dearly beloved " and ends with "amazement," so 
is the schema reflected in the mind of its peruser. 



S6 THE KNOWLEDGE OF MEDICINES. 

who begins with 'Vertigo " and ends witli *'rage." 
Halmemann certainly intended his for no sucli pur- 
pose : it is demonstrable that the a posteriori use of 
them was the only one he contemplated, and that it 
was in view thereof that he published his provings 
in this form. Let us hold his works in all honour. 
Let us give them adequate translation into our own 
tongue, as we in England have lately done with the 
Materia Mcdica Piira, as I hope America will speed- 
ily do with the Chronic Diseases. But let us use 
them aright ; not exhibiting them to outsiders as a 
specimen of what Materia Medica should be, not 
breaking our own or our pupils' hearts by vain at- 
tempts to learn from them what medicines can do. 
For this purpose his prefaces and notes are often of 
the utmost value, for he wrote them from a knowl- 
edge of the detailed provings. But the catalogues of 
symptoms into which he cut up the latter he made for 
reference, and for reference only should they be used. 
Again let me illustrate. In 1847 Dr. Molin, of 
Paris, published the following experiment made on 
himself with Tartar emetic. 

" Being in a good state of health, my pulse 64, I took at 8 
A.M., fasting, five milligrammes of tartar emetic in water. This 
dose was repeated for five days without perceptible effect. The 
sixth day I felt nothing until about 4 p.m. The respiration 
then appeared to me a httle less free. Feeling no further effects, 
and my appetite continuing good, I took about 9 p.m. a dose of 
one centigramme. The night was passed in a restless manner, 
and the sleep interrupted by a fatiguing heat ; I felt necessitated 
to drink several times, the respiration was slightly impeded; on 
rising, general uneasiness, weariness similar to what follows a 



PROVING OF TARTAR EMETIC. 8/ 

febrile fit, the mouth clammy. At 8 a.m. I took one centi- 
gramme. No appetite : a simple soup for breakfast without rel- 
ish. All the day I was in the same state. About 5 p.m. greater 
uneasiness, especially about the epigastric region; nausea; de- 
sire to vomit but without result; respiration more impeded; 
short dry cough, pretty frequent ; great thirst ; heat in the head ; 
white tongue; drinks appear always too sweet; clammy mouth ; 
two loose evacuations during the day; palpitation of the heart; 
bruised feeling and general weariness, compelling me to go to 
bed at eight o'clock. The ear applied to the chest gave e\ndence 
of nothing abnormal, except that the respiration appeared much 
too rough. At 9 P.M. I took 5 milligrammes. Agitated sleep, 
difficult respiration, feeling of pressure on the chest during sleep. 
At 5 A.M. I was awakened by a violent rigor, it lasted twenty 
minutes, and was followed by heat; the pulse, which had been 
little affected during the two previous days, increased to 78, was 
full and strong; skin hot; face red; thirst urgent; heat in the 
head ; pretty strong palpitation of the heart ; slight burning at 
the stomach, — fulness, and inclination to vomit; respiration 
very much impeded ; feeling of pressure and constriction of the 
chest ; cough frequent, and a little moister ; on auscultation, the 
respiration appeared rougher than on the previous evening, and 
deep inspiration was accompanied by slight pain under the left 
nipple. Night very agitated ; nightmare ; disagreeable dreams. 
I felt much the same in the morning as I had the previous day, 
but deemed it advisable not to carry the experiment farther. 
During the subsequent days the following symptoms occurred : 
— the tenth day, no stool; towards evening, pulse 72; respira- 
tion somewhat less difficult; cough the same; hardly any pain 
in the side; great thirst; a good deal of uneasiness; no inclina- 
tion to vomit ; night a little less restless. The eleventh day, a 
little less roughness of breathing on auscultation; cessation of 
the pain; pulse nearly normal; skin still hot; thirst less; uneasi- 
ness diminished; appetite in part returned; respiration still 
obstructed; cough a little less; the night more tranquil. Twelfth 
day, appetite; breathing nearly free; the cough continues; 
scarcely any thirst ; tranquil night. The symptoms continued 



8S THE KNOWLEDGE OF MEDICINES. 

to diminish the subsequent days, so that by the eighteenth there 
remained no trace of indispositions except shght cough, which 
persisted some time longer." 

Now it is quite clear that in this proving of Tartar 
emetic Dr. Molin developed in himself an incipient 
pneumonia ; and the rest of the symptoms (save per- 
haps those of the gastro-intestinal organs) were sj/i- 
droniata of that affection. Read in their connexion 
and sequence, they are easily understood aright ; but 
imagine them cut up for the schema. Imagination 
is necessary here ; as — very fortunately — Dr. Allen 
overlooked Dr. Molin's experiments when compiling 
the pathogenesis of Antimonium tartaricum for the 
first volume of his Encyclopcedia, and so has reserved 
them for the appendix in the tenth volume, where he 
gives them in detail as recorded. But the picture is 
not difficult to construct. The rigor, heat, full pulse, 
and thirst, would appear in the " Fever" section, and 
would seem to shew that Tartar emetic was capable 
of exciting primary pyrexia, and this indeed — seeing 
that there was fever also on the previous night — of 
an intermittent character. The agitated nights, with 
their troubled dreamings, would be classed under 
" Sleep," and would suggest that the drug had power 
directly to disturb this function of the brain ; while 
the palpitations would mislead similarly as to its 
action on the heart. The respiratory affection would 
itself be dismembered ; for cough is always, in our 
schemas, found under the head of "Larynx," while 
the rest of the symptoms would be referred to the 
chest. 



PROVINGS TO BE REPORTED IN DETAIL. iSg 

Said I not truly then that our pathogeneses, in the 
Hahnemannian arrangement, are not intended for 
study ? Their unity is dehberately broken up, that 
they may become an index rather than a text ; and they 
must be used accordingly, for reference and not for 
consecutive reading. To a great extent, as we have 
seen, the sacrifice is made in vain ; for the separate 
symptoms divorced from their context are often unin- 
telligible and even delusive. All that is required 
would have been given by a short repertory affixed to 
each pathogenesis, or group of pathogeneses, shew- 
ing where — if anywhere — individual symptoms might 
be found. In this way the peculiar sensation of the 
sweet taste of drinks, experienced by Dr. Molin, 
might have been noted ; and might have led to a mi- 
nute adaptation of the drug. Hahnemann did some- 
thing of the kind for the pathogeneses of his /v?7^- 
menta de Viribtcs, but he had already adopted for these 
the schema-form. It is too late for any alteration in 
what we have from him : but it is not too late to stop 
any presentation of new provings in this shape. I 
had hoped, until I saw the Transactions of the Amer- 
ican Institute of Homoeopathy for 1 88 1-2, that no one 
would now inflict such a wrong upon us. It seems, 
however, that some of those who call themselves 
"Hahnemannian" feel bound to reproduce, with 
Chinese accuracy, the defects as well as the merits 
of their eponym. Their vicious procedure will call 
down its own punishment ; for in the Materia Medica 
of the future such contributions, if admitted at all, 
will pretty certainly receive the comparative discred- 
iting of smaller type. 



90 THE KNOWLEDGE OF MEDICINES. 

Of this Materia Medica, on which the hearts and 
hopes of many of us are now set, I shall have to 
speak to you in the concluding lecture of this course. 
I shall then endeavour to shew you how you may 
have to your hand records of drug-action answering 
to the clinical aspect of disease, which you may study 
with equal interest and instruction. In the mean 
time, as I have said, — make the best use you can of 
your introductions, and of such detailed provings 
and poisonings as you can pick up from books or 
journals. But do one thing more. I have said that 
the student of disease, if put off with an artificial 
symptomatology, would clamour iox the natural records 
of which he had been deprived. I want you also to 
clamour. If what I have said on the subject has 
commended itself to your minds : if on hearing such 
a narrative as that of Dr. Molin's you have thought 
O si sic omnia ! let your voice be heard, and sic omnia 
will be. I am pleading for the constitution of an 
entire Materia Medica in that form ; and this largely 
in the interest of the students a thousand of whom 
annually fill the Homoeopathic Colleges of America. 
If they will back my plea they will convert it into a 
demand ; and the supply will assuredly follow. 



V. 

PYREXIA AND THE ANTIPYRETICS. 

We have enquired what should be our knowledge 
of disease and our knowledge of medicines, and have 
arrived at certain definite conclusions thereupon. 
From what I know of my friends, the Professors of 
Practice of Medicine and of Materia Medica in this 
School, I have no doubt of being in agreement with 
them as to what you should learn in these departments, 
and as to how your knowledge should be acquired. 
I am no less sure that, under their guidance, you are 
becoming as thoroughly acquainted with disease and 
with drug-action as it is possible for students to be. 
I have nothing to add to what they teach you. I pro- 
pose rather, on most of the remaining occasions of 
my addressing you, to occupy your attention with a 
series of topics intermediate between the spheres in 
which their instructions move. I propose to study 
certain ^r^/// J- of medicines — groups formed naturally 
out of relationships to morbid states or actions on 
the same parts of the body ; and to institute such 
comparisons between the several members of the 
groups as shall bring out their individualities, and 

91 



92 PYREXIA AND THE ANTIPYRETICS. 

thus ensure their accurate adaptation to the disorders 
they have to remedy. Fever and rheumatism are the 
morbid states I shall utilise for the purpose ; while 
for action on the same part of the body I shall study 
the cerebral symptoms of a number of drugs in the 
light of the researches on cerebral localisation which 
have excited so much interest of late. 

Our subject to-day, then, will be the group of drugs 
which, from the control they have shewn themselves 
capable of exercising over the febrile process, may 
be called antipyretics. Before approaching them, 
let us dwell for a time on the process itself, and as- 
certain what is known of its inner nature and of the 
manner of its occurrence. 

That fever, pyrexia, consists essentially in increased 
temperature of the body appears from its name, which 
in both Greek and Latin points to combustion or 
glowing heat (Trvperd?, from -n-vp, fire ; febris^ from fer- 
veo, I glow). We shall see presently that something 
more than heat of body is required to constitute the 
clinical entity we call fever ; but, though there may 
be hotter blood (as ascertained by the thermometer) 
without fever, there cannot be fever without hotter 
blood. Now this organism of ours is so nicely ad- 
justed, both in its inner relations and in its re-actions 
with the environment, that the temperature of our 
bodies is at all times and under all circumstances 
almost uniformly the same. Whether we shiver at 
the poles or swelter within the tropics, whether we 
glow with exertion or feel the chilliness of sedentary 
and indoor life, the thermometer in our armpits tells 



HEAT FORMATION AND RADIATION. 93 

the same tale, and marks 98.4° of Fahrenheit's scale, 
2)7"^ of the centigrade, as our normal heat. There 
are, of course, oscillations about this fixed point, 
according to time of day, meals, exercise, and so forth ; 
but they observe very narrow limits, rarely transcend- 
ing two degrees (up and down) of the one scale or 
one of the other. This uniformity is secured by a 
due compensation between the production of heat 
and its loss. When production is stimulated — as by 
external warmth or physical exertion — the perspir- 
ing skin (with its twenty-eight miles of tubing) allows 
a freer radiation : when heat-formation, in coldness 
or quietude, is small, the dry surface and contracted 
cutaneous arterioles restrain the loss of what there 
is. 

It would seem, therefore, that for fever to exist one 
or both of these compensating functions must be dis- 
ordered. There must be either increased production 
of heat, or diminished loss, or the two must coincide. 
Both of the first two alternatives have had their ad- 
vocates. As regards diminished loss, — restriction 
of heat-radiation may undoubtedly cause elevation of 
internal temperature, as has been ascertained experi- 
mentally during exposure of the skin to cold air or 
water ; but the increase is too moderate to attain of 
itself the febrile height. I think, however, that it 
may be sufficient to set going, in vulnerable tissues, 
the excessive heat-production which the opposite 
theoi^y requires ; and I apprehend that this is the 
rationale of the simple fever which results from a 
chill. While in your country in the summer of 1876, 



94 PYREXIA AND THE ANTIPYRETICS. 

and sitting in the usual perspiration which the ''heated 
term " of that year developed, I went out on a piazza 
to see a thunderstorm advancing over the country. 
The strong blast of wind which so often heralds such 
a storm swept down upon me, and closed my open 
pores with irresistible force. The next day I felt that 
I had "caught cold," and in two days more coryza 
had developed itself, and I had a temperature of 102°. 
This fever was out of all proportion to the local 
symptoms, which v/ere quite moderate. It had been 
forming, I apprehend, ever since my chill ; and its 
starting-point was the check to heat-radiation which 
then occurred. 

I would thus explain "catarrhal fever" by dimin- 
ished loss of heat as its primary cause ; but I have 
already said sufficient to shew that increased heat- 
production must also be set up to constitute the fully 
developed malady. Without it true febrile tempera- 
tures cannot be attained ; and that it is present in 
fever is shewn by the enhanced tissue-waste manifest 
therein. Excess of urea in the urine precedes rise 
of temperature and outlasts its decline, and ranges 
from li to 3 times the amount of its proportion in 
health. What does this mean — there being no 
change in food to account for it — but increased 
oxidation ? and, if Wagner be right in saying that 
"the essential sources of heat in the organism are 
chemical processes, based upon oxidation," then any 
excess in this action implies the production of an 
abnormal quantity of caloric. Nor would the case 
be altered if the protoplasmic doctrine of life were 



HYPEROXIDATION. 95 

to lead us — as some think it does — to refer heat- 
production to the direct metaboHc action of the Kv- 
ing" matter. Excess of tissue-waste must still imply 
increased metabolism of tissue, and with this must 
come increased evolution of heat. 

To hyperoxidation, then (this conception being 
provisionally maintained), we must look as the main 
source of the undue heat present in the febrile 
state. In catarrhal fever, it is probably secondary 
to disorder of the apparatus which permits of heat- 
radiation ; and in fevers dependent upon local inflam- 
mations (including those of hectic type) the tissue- 
destruction may be limited to the seat of mischief. 
But in the essential, toxaemic fevers — in typhus, 
typhoid, variola, scarlatina, and their congeners — I 
take it that we have hyperoxidation of the blood, or 
the tissues, or both, as the primary factor of the 
morbid process. The virus of their contagion, when 
imparted to a susceptible subject, acts as a spark to 
the combustible elements, and the mischief slowly 
or quickly spreads. These fevers are thus more pro- 
longed than those of catarrhal origin, — the latter 
subsiding on the supervention of perspiration, which 
liberates the retained heat and so removes a main 
factor of the whole trouble. 

But there is yet another possible source of increase 
of temperature ; and that is the nervous system. I 
do not mean so much that portion of it which, from 
its influencing the calibre of the arteries through 
their muscular coats, is called vaso-niotor. This, of 
course, is largely concerned in the heat-regulating 



g6 PYREXIA AND THE ANTIPYRETICS. 

function of the surface, in which the blood-vessels 
play so important a part. At one time their con- 
traction, constituting the cold stage, and their sub- 
sequent dilatation, which forms the hot stage, of 
fever, was supposed to be of the essence of the 
process. But it is now known that the chill may be 
altogether absent, so that the hot stage is no mere 
re-active dilatation of the superficial vessels ; and, on 
the other hand, when the chill does occur, it is found 
to be an evidence that the temperature has already 
risen. Its only causal influence can be some amount 
of heat-retention when it is prolonged. Again, after 
paralysis of the vaso-motor nervous system by de- 
struction of the principal centre, no fever is induced 
unless the animal be placed in a hot room. He is 
unduly sensitive to his environment, but is not other- 
wise febrile : indeed, if the temperature be low, he 
will die of cold. But experiment seems to shew that 
there are heat-centres in the spinal cord independent 
of the vaso-motor nerves, and that their injury is 
capable of setting up a great increase of the bodily 
heat. Sir Benjamin Brodie found that at the end of 
forty-two hours after crushing the lower part of the 
cervical enlargement of an animal's cord, the tem- 
perature (centigrade) was 43.9 — the norm being, as 
you know, 37.0 ; and Billroth, Simon and Naunyn 
have seen corresponding effects from injuries of this 
kind in the human subject. Mr. Teale, of Leeds, 
reported a remarkable case to the Lancet in 1875, in 
which the temperature continued above 108° for some 
weeks, sometimes rising to 122° and over. This, too, 



NERVOUS ELEMENT OF FEVERS. 9/ 

was one in which injury to the spine had occurred. 
I have mentioned these facts, though I do not think 
they have much bearing on ordinary fever, — Mr. 
Teale's patient, for instance, having no very marked 
febrile symptoms ; but they possibly account for the 
occasional supervention of that hyper-pyrexia which 
has frequently been noted of late, and which puts 
the patient in such peril. Even for this, however, 
we must have two factors — some pyrogenous mat- 
ter in blood or tissues, and collapse of the heat- 
controlling nervous centres ; for Mr. Teale's patient, 
in whom the latter element presumably existed, 
survived through weeks of a temperature which, 
e.g., in acute rheumatism would kill in twenty-four 
hours. 

There are two other types of fever for which also 
we may look in this direction ; viz., the hectic and 
the intermittent. Either is marked by a series of 
paroxysms made up of more or less chill, heat, and 
sweat, usually occurring in this sequence, and having 
a rapid rise and fall of the temperature of the blood 
as their basis, — the rise being here as elsewhere 
accompanied by increased excretion of urea. In 
hectic, we have a local infective process (as tuber- 
culisation of the lungs) where suppuration is going 
on ; and any continuous pyrexia which is present 
may be explained as is that of the fever symptomatic 
of inflammation of any part. For periodical parox- 
ysms of the kind, however, we must invoke the 
agency of the nervous system ; for we can hardly 
suppose, as some have done, that the pyrogenic 



98 PYREXIA AND THE ANTIPYRETICS. 

matter accumulates and discharges itself with such 
rhythmical regularity as seen, for instance, in the 
diurnal pyrexia of phthisis. The malarious fevers 
may be similarly regarded. Here, too, the exciting 
cause is probably of a substantive character, i.e., it 
consists of an abundance of low forms of vegetable 
life ; but here too, I think, we must look to the 
nervous system as the source of the paroxysms. It 
may be that thus is explained the fact so often 
noted, that it is easier, with the attenuated remedies 
of homoeopathy, to cure chronic intermittents than 
acute ones. The latter have the cause still present 
and in operation : the former consist rather in a mor- 
bid habitude of the nervous centres, which a strong 
mental impression will often remove as effectually as 
an appropriate drug. 

From the nature of fever we may now pass to the 
forms under which it is manifested. The classifica- 
tion generally accepted in the last century was that 
an outline of which you see on the board. 



Symptomatic . 


Inflammatory. 

Hectic. 

Intermittent. 








Idiopathic . . 


. < Remittent, 


■ Synocha. 








t Continued . . 


■ Synochus. 
Typhus . , 


( Nevvosus. 
( Putridus. 


Versatilis. 

Stupidus. 



" Symptomatic " fever was that obviously depend- 
ent on some local inflammation ; and, if continuous, 
was known simply as "inflammatory," while, if it 



CLASSIFICATION OF FEVERS. 99 

occurred in a succession of daily paroxysms, it was 
called ''hectic." "Idiopathic" fevers were those 
apparently of primary origin ; and these too were 
divided according as their phenomena were ''inter- 
mittent," "remittent," or ".continued." Continued 
fevers were further subdivided on the basis of the 
character of their symptoms. If these were of the 
simple and sthenic kind familiar in inflammatory 
fever, the term " synocha " was used to designate 
the patient's illness. If of a somewhat lower type, 
"synochus" was substituted as their designation; 
leaving "typhus" for the well-marked "low fever," 
and adding "nervosus " or " putridus " as the stress 
of the disease seemed to fall on the nervous centres 
or on the blood. The " versatilis " and " stupidus " 
further qualifying the typhus nervosus need no ex- 
planation. 

Such a classification is obviously unsuited for 
nosology, when once the essential nature of certain 
fevers, and their dependence upon definite miasms 
or contagions, is recognised. The distmction of 
symptomatic and idiopathic pyrexia still indeed holds 
good, and pyaemia and septicaemia find appropriate 
place as varieties of hectic. But intermittents and 
remittents are now classed together as malarious ; 
while continued fevers are recognised as occurring 
under the four forms of ephemera, relapsing fever, 
typhus, and typhoid, to which some would add a 
"common continued fever" — \\).^ fikwe synoque of 
the French, the "gastric fever" of popular English 
speech. Thus we get the second schema presented 
to us. 



ICO 



PYREXIA AND THE ANTIPYRETICS. 





Inflammatory. 




Symptomatic . . ■ 


Hectic. 
Pyaemia. 
Septicaemia. 






Halations. 


Ephemera. 


Idiopathic . . . ' 




Gastric. 




Continued . . . < 


Relapsing. 
Typhoid. 
. Typhus. 



Now, speaking generally, there is a tolerable coin- 
cidence between the apparent and the real types. 
Ephemeral fever is synochal in character ; relapsing 
and gastric fevers would of old have been called syn- 
ochus ; while typhus and typhoid commonly present 
the characters of the typhus putridus and nervosus 
respectively. But, while this is so, we must not let 
the ancient distinctions be swallowed up in the mod- 
ern, as though wholly obsolete. While the latter are 
all-important for prognosis of the course and probable 
termination of fevers, and for their general manage- 
ment, the former still hold good for therapeutic pur- 
poses. They are symptomatic, and therefore lend 
themselves with great appropriateness to a method 
of drug-selection like ours which uses symptoms as 
its materials. They also enable us to embrace such 
fevers as the catarrhal and rheumatic, and that ac- 
intagious exanthemata, which — 
place in the usual classifications 



companymg the 

though not finding 

— are no less genuine clinical facts. The same may 

be said of those recognised varieties of our common 



TREATMENT OF FEVERS. lOI 

continued fevers which are now referred to the 
"typhoid" or "gastric" category. Trousseau gives 
them as "mucous," "bilious," "inflammatory," "ady- 
namic," "putrid," "ataxic" and "malignant." Our 
own Trinks, to whom we owe a valuable study of 
"abdominal typhus" (i.e. typhoid) in its drug-rela- 
tions,' describes it as occurring under the forms 
" simplex, " " biliosus, " " pituitosus, " " putridus, " 
"nervosus versatilis"and"nervosus stupidus." While 
the essential fever thus manifesting itself may be 
one and indivisible, the various forms under which it 
appears are no less realities, and require a suitable 
adjustment of our drug-remedies, as they do of those 
of a more general kind. 

Coming now to the treatment of fevers, it is first 
of all necessary to recognise that pyrexia, as such, is 
an evil state, fraught with untold injury to its sub- 
ject. We know how twenty-four hours of it, in its 
simple catarrhal form, will weaken a strong man ; and 
after the three weeks of it in typhoid Liebermeister 
well describes the body of the convalescent as "emer- 
ging hke a wreck from a storm ; on the one hand, 
having to throw overboard ruined parts and clear the 
deck, on the other, to restore sails and rudder." It is 
most desirable, therefore, to abate its severity and — if 
possible — shorten its duration. In ordinary practice 
this is aimed at by cold baths, or by drugs like qui- 
nine and salicylic acid. It is a rough, crude treat- 
ment, directed — as Dr. Cretin has justly pointed out 
— against one element only in fever, viz. : the high 

^ See Brit. Joiirn. of Ho>n.\o\. xxix. 



I02 PYREXIA AND THE ANTIPYRETICS. 

temperature ; but, nevertheless, it seems to be better 
than expectancy. Sassetzky, of St. Petersburg, has 
lately instituted a special enquiry into its merits, with 
very favourable results. He found that invariably 
the cold bath diminished the elimination of nitrogen, 
and that a similar but far less marked diminution oc- 
curred in the cases treated by quinine and the sali- 
cylate of soda. The quantity of urine was increased 
by each method, but to the largest extent by the bath. 
The assimilation of the solid and nitrogenous constit- 
uents of milk was improved under the bath treatment, 
as shewn by the very marked diminution in the faecal 
elimination of nitrogen ; and the same fact was also 
noticed, to a less degree, under the other methods. 
The quantity of water ingested was diminished, and 
also the loss of water by the lungs and skin, except 
under the salicylate, when the cutaneous loss was in- 
creased. These are results which shew that, dur- 
ing the febrile state, the patient is in a far better 
condition under the antipyretic treatment than with- 
out it. It is for us to demonstrate that we can, by 
non-perturbative internal medication, do as well as or 
better than our old-school colleagues ; and spare 
patients the distress of cold bathing and the injury 
of the necessarily large doses of quinine and the 
salicylates. Comparative studies on a large scale are 
the only means of proving that we can do so ; but in 
the mean time we can study our available means, and 
see what are at least their positive virtues. 

We turn accordingly to our antipyretic medicines, 
which we may reckon as fifteen in number, viz. : — 



ACONITE. 103 

Acidum muriaticiim. Cinchona (and Quinine). 

Acidum phosphoricum. Crotalus (and Lachesis). 

Aconite. Gelsemium. 

Agaricus. Hyoscyamus. 

Arsenicum. Rhus. 

Baptisia. Stramonium. 

Belladonna. Veratrum viride. 
Bryonia. 

They must be considered in their relation to the 
febrile process itself, and to the kinds and shapes in 
which it has come before us. And this we shall best 
do by taking certain representative medicines, and 
counting them as types, under whose headings the 
others may find their appropriate place. Such typical 
drugs are Aconite, Belladonna, Arsenic, and Bryonia. 
I. The history^ of Aconite as an antipyretic is the 
history of homofopathy. What was known of it up 
to 1805 had led to its use in a few chronic affections 
only. In that year Hahnemann published his Frag- 
mcnta de Viribiis, which contained — among others — 
a pathogenesis of this plant. It shewed its power of 
producing a series of paroxysms of alternate chill 
and heat, ''repeated two, three, or four times before 
the whole effect ceased, which it did in from eight to 
sixteen hours." In 181 1, republishing this pathogen- 
esis (with additions) in the first volume of his Ma- 
teria Mcdica Pitm, he prefixed some remarks pointing 
to the above-named features of its action as promis- 
ing usefulness from it in acute diseases. Of -what 
kind these should be he had not then perceived. But 
somewhat later, while treating some inflammatory 



104 PYREXIA AND THE ANTIPYRETICS. 

disorders he was led to the employment of Aconite 
from the similarity of some of the concomitant symp- 
toms with some in its pathogenesis, and he found its 
administration followed by a great diminution in the 
frequency of the pulse, and a cessation of the febrile 
state. He followed up this hint; and in 1822 was 
able to proclaim it the one sufficient remedy for states 
against which the whole antiphlogistic apparatus of 
that day (and you know how heroic this was) was 
considered necessary — the ''pure inflammatory fe- 
vers." It has continued to be so reckoned ever since 
in the school which he founded, and has of late won 
no small acceptance in the ranks of those who (at 
least outwardly) reject his method. 

Remembering this history, we turn over one of the 
latest treatises on Materia Medica and Therapeutics 
to see what is said on the subject. Dr. Bartholow, 
in 1877, writes: — ''The monopoly by homoeopathic 
practitioners of the use of aconite has roused a preju- 
dice against it, which has discouraged its employment. 
Aconite is, however, an antagonist to the fever-pro- 
cess ; it is not applicable in accordance with the so- 
called law of similars. It is used by these quacks 
because it is a powerful agent which will produce 
manifest effects in small doses, that may easily be dis- 
guised." One hardly knows whether most to smile 
at the ignorance or sigh at the insolence of this 
statement. That Hahnemann was the discoverer of 
the antipyretic power of Aconite, and that he arrived 
at it by working with the law of similars, is manifest 
from the facts of the case : that he required for its 



ACONITE. 105 

exercise no doses which needed disguising, however 
easy, appears from his recommendation (in 1822) of 
the 24th dilution as sufficient for the purpose. That 
Dr. Bartholow's own knowledge of this use of the 
drug is lineally derived from him is also readily de- 
monstrable. His immediate inspirer is evidently — 
from his quotations — Dr. Sydney Ringer ; and 
whence did he learn it.? In January, 1869, he wrote 
a paper on Aconite in the Lancet, which begins — 
** Of all the drugs we possess, there are certainly 
none more valuable than aconite. Its virtues by 
most persons are only beginning to be appreciated, 
but it is not difficult to foresee that in a short time 
it will be most extensively employed in the diseases 
immediately to be noticed." And these are, inflam- 
mation and its accompanying fever. Dr. Ringer im- 
plies that he is making a new departure in the em- 
ployment of the medicine, and the silence of the 
Materia Medicas of the day substantiates the assump- 
tion. He is equally silent as to the source of his 
fresh knowledge ; but the homoeopathic history of 
the drug fills up the gap he has left. I venture to 
think that my own attempt to make our Materia 
Medica intelligible and interesting to outsiders had 
some share in this result ; for my Manual of Phar- 
inacodyhamics first appeared in the summer of 1867, 
and of course contained the statements which, eigh- 
teen months later. Dr. Ringer so emphatically war- 
ranted. 

That it was the homoeopathic method — small dose 
and all — which first revealed the antipyretic virtues 



I 



I06 PYREXIA AND THE ANTIPYRETICS. 

of Aconite, and that it is homoeopathic literature 
from which all knowledge of it has been derived, is 
thus the plain witness of history. But what of Dr. 
Bartholow's further contention, that " Aconite is 
an antagonist to the fever-process," that "it is not 
applicable in accordance with the so-called law of 
similars " .'* To answer this question we must ask a 
previous one, — what is the "so-called law of simi- 
lars".? It is — as Hahnemann, always laid it down 

— similia siviilibus cnre7it2n\ let likes be treated by 
likes. It assumes nothing about processes or antag- 
onisms : it simply requires correspondence — as close 
as possible — between the phenomena of disease and 
of drug-action. How a remedy, prescribed on such 
indications, acts within the organism has always been 
left an open question ; and the majority of those who 
have thought about it, from Hahnemann himself 
downwards, have regarded it as probable that, appar- 
ently homoeopathic, it is really antipathic to the 
essential morbid process. Let it be granted that 
Aconite so acts in fever : how does it make against 
the claim to it of the method of Hahnemann, unless 
it can be shewn that the drug does not cause fever 

— is not febrigenic t Dr. Bartholow might even 
deny this, as he is of course ignorant of homoeopathic 
literature, and does not seem acquainted even with 
the experiments of Schroff. The latter would give 
him some pretty evident febrile symptoms ; but the 
Austrian provings of our own school, from milder 
and more repeated doses having been taken, exhibit 
the result far better. Here is one of them, which I 



ACONITE. 107 

extract from a monograph on the drug by Dr. Dud- 
geon in a forthcoming volume to be issued by the 
Hahnemann PubHshing Society: — -. 

*'A. B., a healthy peasant girl, very robust, aged 
22, took on successive days 5, 10, and 20 drops of 
tincture without effect." This was of course the 
Hahnemannian tincture of the whole plant, which is 
comparatively a weak one. "On the i8th January 
took 30 drops ; confusion of head, feeling of heat in 
the evening. 19th. — 40 drops ; after two hours con- 
fusion of head, sometimes changing into heavy feel- 
ing and pressive pain in crown and forehead ; loath- 
ing, nausea, general malaise with painful heaviness in 
limbs. After five hours pressive pain in scrobiculus 
cordis, dry feeling in mouth, great thirst. Felt so 
unwell, head so confused, giddy, and painful, and 
limbs so heavy, that she had to go to bed. Face 
hot, hands and feet cold, pulse contracted, hard, 
moderately quick. After nine hours, pressive pain 
in forehead, face turgid red, eyes sparkling, dry feel- 
ing in mouth, tongue moderately moist, slightly 
furred, no appetite, great thirst, oppression of chest, 
shallow quick breathing, with frequent deep breath- 
ing and sighing. No pains, but heaviness and ful- 
ness in chest, anxiety and palpitation of heart. 
Heart's beat strong, pulse fuller than usual, hard 
and strong, at same time moderately quick, skin 
warm, urine clear and reddish. After twelve hours 
heat and restlessness increased, tosses about from 
one side to another. In right thorax some pressive 
pain. After sixteen hours (9 p.m.), more tranquil 



I08 PYREXIA AND THE ANTIPYRETICS. 

the last hour, general warm sweat : headache, throat, 
and breathing difficulties relieved ; pulse large, soft 
and slow. Only confusion of head and perceptible 
beating of heart complained of." Next day she was 
nearly herself again. 

This — which finds several parallels in the Aus- 
trian provings — should be sufficient ; or, if any dis- 
trust observations on the human subject, they may 
be referred to Dr. Mackenzie's experiments on ani- 
mals recorded in the Pi'actitioner of 1878-9. He 
found Aconite always to increase the temperature 
until asphyxia set in — the thermometer in the ear 
of a rabbit rising from two to four degrees Fahren- 
heit under its influence. Aconite is undoubtedly 
febrigenic ; and that its curative action is homoe- 
opathic is also shewn by the small doses with which 
it may be effected. Hahnemann was content, as we 
have seen, with the 24th dilution ; and though most 
of us now-a-days prefer to go lower in the scale, yet 
who can suppose that the thousandth part of a drop 
of the juice can act as an "arterial sedative," while 
in such dosage (the 3rd decimal) the drug is most 
promptly febrifuge in cases suitable for its adminis- 
tration. 

And now, what are these cases } When Hahne- 
mann spoke of the '* pure inflammatory fevers " as 
its sphere of action, it is obvious that he did not 
mean so much the fever symptomatic of local inflam- 
mation, as that which from its resemblance thereto 
was named "inflammatory," under whatever circum- 
stances occurring. For he specifies, as instances of 



ACONITE. 109 

its efficacy, measles, purple-rash, and pleurisy — the 
third only having any local affection as its basis. 
The Aconite-fever is thus essentially a synocha, and 
whenever this type presents itself the drug is indi- 
cated. It may occur in the exanthemata, after pass- 
ing a catheter, or as the result of cold ; but always 
and everywhere Aconite is its great remedy. It is 
rarely if ever present in the fevers we call toxaemic, 
as resulting from some morbid poison ; and in the 
treatment of these — in typhus, typhoid, variola, and 
such like, Aconite plays but a small part. The same 
may be said of such blood-poisonings as septicaemia 
and pyaemia. As regards the fever symptomatic of 
local mischief, — when this is of a character to induce 
hectic, Aconite certainly finds no place. But what of 
pure inflammations and their accompanying pyrexia ? 
Hahnemann commended it for these where "with 
thirst and rapid pulse, an anxious impatience, an 
unappeasable restlessness and an agonised tossing 
about are conjoined." Carroll Dunham has well 
shewn that these are the symptoms present when 
an inflammation is yet quite incipient. When sub- 
stantive local changes have occurred, the tension of 
the circulation and nervous system diminishes, and 
any subsequent fever is sympathetic only. This 
Aconite will not touch : its place, as Teste says, is 
*'in phlegmasiae primarily general, and only second- 
arily localised;" and in these — I may add — only 
before the localisation is complete. 

These canons about the relation of Aconite to 
inflammatory fever may be well illustrated by the 



no PYREXIA AND THE ANTIPYRETICS. 

example of pneumonia. The pyrexia of this disease 
seems quite independent of the phlegmasia: it pre- 
cedes any manifestation of the latter by physical 
signs, and subsides while these are yet in full pres- 
ence. Aconite would therefore appear to *be thor- 
oughly suited to its incipient stage ; and there are 
some,- both in our own school and in the other, who 
maintain that — given in time — it can abort the 
disease. But careful clinicians like Jousset and 
Kafka warn us against indulging such expectations, 
and my own experience is entirely in accord with 
theirs. The acute pulmonary attack which Aconite 
so promptly resolves is congestion, — a condition 
which never goes on to croupous exudation, but — 
if not arrested — leads to oedema pulmonum and 
death. It is very rapid and dangerous, and to have 
such a remedy for it as our present drug is a great 
cause for thankfulness. But it is not pneumonia. 
The rigor with which this malady generally sets in 
indicates that the lung is already inflamed, and has 
heated the blood up to shivering-point. You may 
not yet hear any thing abnormal on auscultation and 
percussion ; but if you will count the respirations, 
you will find that they are rapid out of all propor- 
tion to the pulse. When this is so, let me urge you 
to waste no time in administering Aconite, but to 
give Bryonia or Phosphorus, Antimonium tartari- 
cum or Iodine, according to the patient's symptoms 
and condition. You will under these find pulse and 
temperature subside, gradually indeed, but with all 
reasonable rapidity, and that from the very first ; 



ACONITE. Ill 

while the physical signs diminish 2\vciO'S>\. pari passu. 
If twenty-four hours are thrown away in Aconite- 
giving, you are more likely to have the sudden de- 
fervescence seen in cases left to expectancy (which, 
as the late Professor Henderson shewed, is due to 
compression of the pulmonary circulation by the 
filling up of the air-cells) with slow resolution of 
the exudation. 

Putting all these things together, and remember- 
ing what we have learned to-day concerning pyrexia 
in general, it would appear that the sphere of Aco- 
nite is the nervous system of the circulation ; and 
just so far as a fever belongs to this portion of the 
organism, so far can this drug induce it in the healthy 
and remove it in the sick. It is antipyretic, not by 
diminishing the hyperoxidation on which (ordinarily) 
depends excessive heat-production, but by regulat- 
ing the apparatus provided for heat-liberation. It is 
in the fevers brought on by a chill, and in whose 
hot and cold stages alike the skin is dry and the cu- 
taneous vessels tense, that it displays its greatest 
powers. And hence, on the one hand the rapidity, 
on the other the short duration, of its action. When 
once the tension of the nervous and circulatory sys- 
tems has been relaxed, and the pent up heat liberated, 
Aconite has nothing more to do ; but this admits of 
being done within a very short time, and Aconite can 
do it. We do not continue this remedy for days 
together, as with Belladonna and Arsenic. Hahne- 
mann's single dose, or the frequent repetitions of the 
later practice of most of us, accomplish their work in 



112 PYREXIA AND THE ANTIPYRETICS. 

twenty-four hours at the utmost ; and then, if neces- 
sary, other remedies come in. 

The only other antipyretic which can be classed 
with Aconite is Gelscniiiim, for Veratrum viride — 
which some suppose analogous to it — seems to me 
to belong rather to the Belladonna group. Of the 
reputation with which Gelsemium came to us from 
the ''Eclectic" school of this country its power over 
fevers formed no small part. Dr. Douglass, its earliest 
prover, obtained results which shewed its action in 
this sphere to be of the homoeopathic kind. Experi- 
menting on some seventy persons, he found it not 
unfrequently to induce, in a few minutes, a marked 
depression of pulse, with chilliness especially along 
the back, cold extremities, and heat of head and face, 
with pressive headache. This was soon followed by 
a glow of heat and prickling of the skin, with full 
pulse, rising as much above its normal standard as 
before depressed below it ; and then came perspira- 
tion, sometimes profuse and lasting from twelve to 
twenty -four hours. In reply to an objection that 
others had not been able to produce these symp- 
toms, Dr. Douglass wrote that the degree of chill and 
febrile re-action in his subjects bore a very uniform 
ratio to the nervous sensitiveness of the patient. In 
some, where this quality was very marked, "the chill 
was equal to a respectable fit of the ague, the re- 
action and pain of head corresponding, and the sweat 
profuse." ' 

Thus also must be explained the negative results 

* Hale. New Remedies. 2nd ed., p. 409. 



GELSEMIUM. II3 

of Drs. Ringer and Murrell, in their recent provings, 
with regard to fever ; though they acknowledge, in 
one-third of their observations, a quickening of the 
pulse ranging from six to twelve beats in the minute, 
and in one experiment a rise of .2° to .4° Fahren- 
heit in temperature. The drug is certainly not anti- 
pathic to the febrile state, and yet its virtues therein 
are largely acknowledged. Dr. Douglass's state- 
ments favour the idea that it is in neurotic fevers 
that it is likely to find its best employment — in those 
which start with heat-confinement, and subside with 
heat-liberation. There is a remittent fever often seen 
in childhood, but not absent from adults, arising from 
various causes, but marked by this, —that the heat 
is almost absent in the early part of the day, increases 
towards evening, and subsides ivithoitt perspiration as 
the night wears away. Gelsemium is as effective in 
this pyrexia as Aconite in its own. Even in the lat- 
ter, it may vie with its prototype when, instead of 
anxious restlessness and craving thirst, there is rather 
a torpid and heavy condition, with a pulse not very 
rapid and inclined to be full and soft. The Gelsem- 
ium fever is a synochus rather than a synocha, — 
the main symptoms being those of languor and op- 
pression, with dark crimson face, and dull pains in 
head, back, and limbs, the head feeling large and 
full. On this it acts with much rapidity, speedily 
relieving heat, oppression and aching. You may 
meet such a pyrexia as the result of a chill, in in- 
fluenza, and in the milder exanthemata. It may also 
characterise some of the less pronounced malarious 



IT4 PYREXIA AND THE ANTIPYRETICS. 

fevers, especially in imperfect convalescence after 
the intermittent paroxysms have been broken by 
quinine. Whether Dr. Hale's recommendation of it 
in hectic can be sustained, I am unable to say. 

At our next meeting we will take up the groups 
of antipyretics headed by Belladonna, Arsenic and 
Bryonia respectively. 



VI. 

PYREXIA AND THE ANTIPYRETICS {coniinued). 

II. In 1838 Dr. Graves, the celebrated clinician of 
Dublin, advocated the use of Belladonna in those 
cases of fever with cerebral disorder which are at- 
tended with contraction of the pupil. He supposed 
that the mydriasis caused by it was due to its action 
on the brain, and that a cerebral condition accompa- 
nied by myosis must be precisely opposite in character. 
Hence, on the principle contraria contrariis — always 
influential with though often repudiated by our old- 
school colleagues — he argued that it ought to be 
beneficial in such conditions ; and supported his con- 
tention by several successful cases. His paper on the 
subject may be read in the Dublin yonrnal of Med- 
ical Science for July in the year mentioned. 

We now know that Graves' assumption was incor- 
rect ; that Belladonna does not dilate the pupil through 
the ocular nerve-centres, but by a peripheral action. 
The condition of brain it sets up would be accompanied 
with contraction of the pupil, were it not for the 
local influence it exerts on the ciliary nerve-termina- 
tions in the iris. To idiopathic cerebral states, there- 



Il6 PYREXIA AND THE ANTIPYRETICS. 

fore, of which myosis Is a feature, it bears the rela- 
tion of similarity instead of opposition ; and Graves 
was practising homoeopathy without knowing it. A 
man like Pereira felt there was something: wrons: 
about the proceeding, and justly argued that — on 
accepted principles — Belladonna should be contra- 
indicated in febrile and acute inflammatory cases. 
This seems to have been the general feeling, and 
Belladonna found no place in the treatment of fevers 
for another thirty years. 

In 1869, however, Dr. John Harley published his 
Old Vegetable Neurotics, and one of the drugs studied 
therein was Belladonna. In regard of its relation to 
fever he speaks of " the similarity of the general 
phenomena which attend its operation and those 
which accompany pneumonia, enteritis, the develop- 
ment of pus in any of the tissues or organs of the 
body ; " and says — " an infinitesimal quantity of atro- 
pia — a mere atom — as soon as it enters the blood, 
originates an action which is closely allied to, if it be 
not identical with, that which induces the circulatory 
and nervous phenomena accompanying meningitis, 
enteric, or typhus fevers." These statements are 
based on experiments shewing that the drug causes 
a decided increase in the force and frequency of the 
circulation, dryness of the mouth and tongue, an ele- 
vation of temperature, and an increase of the urinary 
solids. One would have expected that, under these 
circumstances, the presence of fever would have been 
to Dr. Harley, even more certainly than it was to 
Pereira, a contra-indication for Belladonna. It is just 



BELLADONNA. 11/ 

the other way. In the therapeutical chapter, the first 
four maladies mentioned as under the control of the 
remedy are pneumonia, enteric fever, typhus, and 
acute nephritis. When we come to enquire how he 
could be led into such practice, we find, for the local 
inflammations, a theory that the Belladonna dispels 
the stasis by its stimulation of the sympathetic fibres, 
and consequent narrowing of the capillaries ; but as 
regards the fever, whether secondary or primary, all 
pretence at antipathy is given up. ** Two similar 
effects," he writes " the one arising from a local irri- 
tation, and the other from the presence of belladonna, 
like spreading circles on a smooth sheet of water, 
interfere with and neutralise each other ; " and again 
— " it appears that the stimulant action of belladonna 
is converted in great measure in febrile diseases into 
a tonic and sedative influence." 

This was somewhat bare-faced homoeopathy to be 
professed by a hospital physician and Gulstonian lec- 
turer ; but it is characteristic of the advance of med- 
ical thought that no exception was taken to it. I am 
not aware that the practice has gained much accept- 
ance ; but it is mentioned by all writers on pharma- 
cology and therapeutics, and no one objects to it on 
the score of its homoeopathicity. The febrigenic 
power of the remedy is admitted by all ; and Dr. de 
Meuriot, in his Etude de la Belladonne, relates obser- 
vations shewing its power to raise the temperature 
in dogs from i to 4 degrees of the centigrade scale, 
and in man from i to i^^. 

In the school of Hahnemann this property of the 



I l8 PYREXIA AND THE ANTIPYRETICS. 

drug has long been recognised and turned to account. 
In the first edition of the Reine ArzneimittcUcJire 
( 1811 ) the master gave numerous extracts from cases 
of poisoning which shewed fever as resulting from it ; 
and the provings of his associates which swell the 
pathogenesis in the later editions exhibit many symp- 
toms of the same kind. Hahnemann himself, as we 
know, was led by the principle of similarity to employ 
it in one febrile state as early as 1799, viz. : in scarla- 
tina. He does not speak of any other in his subse- 
quent writings ; but the obvious application must 
have been largely made, for in Hartmann's Practical 
Obsej'vations on some of the chief Homoeopathic Reme- 
dies, published in Germany in 1839, and translated 
here by the late Dr. Okie in 1846, Belladonna is given 
a high place in the treatment of many forms of fever. 
We have now to enquire what these forms are ; to 
what fevers it is suitable. And here our attention 
is at once drawn to the marked action of Belladonna 
on the nervous centres. It is one of the "narcotics " 
of old, of the " neurotics " of present nomenclature : 
the sensorium is readily disordered by it, and delirium 
is among the most prominent of its poisonous effects. 
The inference is that its fever is due to hyper-oxida- 
tion of nervous tissue, and this is substantiated by 
the fact that it is the phosphates of the urine which 
specially shew increase under its influence. Here is 
a pathological thought to guide us ; and it will lead 
us, as the symptomatic phenomena of the drug led 
our predecessors, to fevers of the typhous kind as 
especially calling for its use. The "typhus nervo- 



BELLADONNA. II9 

siis " of the old nomenclature is its special sphere, 
best when this is also " versatilis," but not excluded 
(as Hartmann has shewn) when it may be called 
** stupidus." Of the essential fevers now recog- 
nised, the typhus and enteric types are those in 
which it plays its chief part ; and it finds here a 
symptom very characteristic of it — the dry tongue. 
This is one of the most readily-induced physiological 
effects of Belladonna ; and Dr. Harley has shewn it 
to be coincident with rise of the pulse, and to be 
replaced by a peculiar moisture on its fall. It is 
itself, moreover, no mere deficiency of secretion 
from inertness of glands or occlusion of blood- 
vessels. The parts are dark-red and congested, 
and the mouth is hot : we have (again to quote Dr. 
Harley) ''a condition which exactly resembles that 
accompanying the typhus state." 

There is another feature of the Belladonna-pyrexia 
which suggests the forms of fever to which it is appli- 
cable, and this is the rash on the skin so often ob- 
served. It is usually compared to that of scarlatina, 
and, with the fever itself, the sore-throat, and the 
delirium, it makes the drug's action a singularly 
close analogue to the disease. You know how this 
similarity was turned to account by Hahnemann, in 
proposing Belladonna as a prophylactic against scar- 
latina; and the success of the practice is vouched 
for in quarters far removed from his influence. In 
the malady itself, in its ordinary forms, the medicine 
should always be given ; though I find it hard to say 
what is the precise amount of control exerted by it. 



120 PYREXIA AND THE ANTIPYRETICS. 

Much more striking is its action in the initial fever 
of variola, where also, every now and then, erythema- 
tous and scarlatiniform exanthemata precede the 
distinctive pustular inflammation, as Simon and 
Curschmann have shewn.' Aconite has no influ- 
ence here ; but Belladonna can produce a decided 
abatement of the pyrexia and pains, even before the 
pocks come out. This is vouched for by physicians 
of both schools ; and I can add my mite of confirma- 
tion to their testimony. 

I have no desire, in these lectures, to make any 
pronouncement on the subject of dosage. But I 
must point out that confidence in Belladonna as an 
antipyretic is most felt and expressed the less atten- 
uated the form in which it is given. If you read 
Hartmann's essay (who used it at about the 30th 
potency), you will find it rather coming in to meet 
special indications in the course of fevers than to 
control the entire pyrexia. Those who give from the 
third dilution downwards have learnt to trust in it as 
a medicine which gives them real povyer over the 
febrile process. It does not act rapidly, as Aconite 
does, — the nature of the fevers to which it is appli- 
cable does not allow of this ; but steady persever- 
ance with it will give the most gratifying results. 

With Belladonna are to be classed its two sister- 
drugs — Hyoscyamus and Stramonium, and, more 
remotely, Agaricus and Veratrum viride. Let me 
say a few words upon each. 

I. Hyoscyamus appears to cause fever as Bella- 

^ Ziemssen's Cyclo/>iedta^ vol. II. 



HVOSCYAMUS. 121 

donna does, by setting up hyper-oxidation in the 
nervous centres. In doses insufficient to dry the 
mouth and tongue, it actually lowers the pulse ; but 
when that full effect of it is obtained, "the pulse" 
(writes Dr. Harley, who has experimented on this 
''old vegetable neurotic" also) ''will generally ex- 
perience an acceleration of lO to 20 beats, and be 
increased slightly in force and volume." With this 
the face will be flushed and the head oppressed ; 
while the urine, if examined, will shew an increase 
in the urea, the phosphates and the sulphates, as 
with Belladonna, but not so marked. A reference 
to the "Fever" section of Allen's Encyclopcedia will 
manifest general heat of surface as no uncommon 
feature of poisoning by the drug. 

From Hahnemann onwards, Hyoscyamus has been 
esteemed by us a valuable remedy in "cerebral 
typhus." To indicate it in preference to Belladonna, 
the head symptoms should be those of oppression 
rather than of excitement, though there may be 
•hallucinations or (if the patient is unconscious) inco- 
herent mutterings. The curious condition known as 
"coma vigil," where the patient is wide awake and 
yet insensible to surrounding objects, has been pro- 
duced by it and will generally indicate it. In similar 
states occurring in other fevers, as the puerperal and 
(as I have just lately seen) that of measles, Hyoscy- 
amus will give every satisfaction. 

2. Of the power of Straiiioniinn, in poisonous 
quantities, to cause fever, we have evidence as good 
as for that of Hyoscyamus ; and, its influence on 



122 PYREXIA AND THE ANTIPYRETICS. 

the nervous system and other parts being so very 
like that of Belladonna, its modus opej'andi as febri- 
genic may fairly be presumed identical. As com- 
pared with the latter, it causes more functional 
excitement of the brain, but less active determination 
of blood thereto. Its delirium, indeed, approaches 
to mania; and on this very account it is less fre- 
quently indicated in fevers than the other mydriatics. 
Where, however, its more intense nervous erethism 
is present ; where there are convulsive movements, 
trembling, restlessness, loquacity, emotional agita- 
tion, you may substitute it for its congeners with all 
confidence. 

3. That AgaidciLS is febrigenic, we are hardly war- 
ranted in affirming. Some apparently febrile chilli- 
ness was observed by Lembke, in his proving on 
himself ; and some heat symptoms are reported by 
two of Hahnemann's provers. On the other hand, 
the very thorough experimentation of the Austrian 
Society failed to develope any thing of the kind. 
Roth rested his commendation of it in ataxic typhus 
on other grounds. "The uncommon weakness" he 
writes "and bruised feeling of the muscles of the 
back and lumbar regions, the meteorism, the rum- 
bling, the diarrhoea, the prostration of strength, the 
stupefaction, the delirium, the small pulse, the trem- 
bling motions of the extremities, and many other 
symptoms of the central nervous system, exhibit 
great similarity to the ataxic forms of typhus fevers." 
The indication has been abundantly verified, both in 
this country and in my own : I, too, can bear witness 



VERATRUM VmiDE. 1 23 

to its soundness. Tremor, loquacity, restlessness 
and constant desire to get out of bed, are the indi- 
cations for it ; while the delirium and unconscious- 
ness of Stramonium are absent. 

4. Of Veratnim viride a somewhat similar account 
has to be given.' It is not for us to use it as an 
arterial sedative : the advocates of contraria co7itrariis 
may do their best (or their worst) with it after this 
manner. Experimentation on animals shews that 
over and above the actions which conduce to this 
result it has a direct influence on the nervous cen- 
tres, — one of its alkaloids, viridia or jervia, causing 
convulsions demonstrated to be of cerebral origin, 
and post-mortem investigation showing intense capil- 
lary congestion within the cranium, especially about 
the cerebellum and pons. In the human subject 
choreiform muscular contortions and paroxysms of 
opisthotonos have been observed from over-dosing, 
and much pain was felt by the provers in the frontal 
region and the neck. It is where, therefore, in fever, 
erethistic and hyperaemic conditions of brain and 
cord occur that the drug should prove homoeopathi- 
cally useful ; and so it has been. It appears to be 
of real value in the incipience of the epidemic cere- 
bro-spinai meningitis which sometimes invades your 
country, and also to be specially suited to the condi- 
tion of the nervous system and the circulation in the 
lying-in woman. Dr. Ludlam, one of the best of 
our authorities here, speaks of its " wonderful power 
to control and to regulate the vascular movements, to 
equalise the circulation, and^ as it were, to stamp out 



124 PYREXIA AND THE ANTIPYRETICS. 

a local congestion that would almost inevitably result 
in inflammation," when occurring in the puerperium. 
'* It restores the milk and lochia, when these have 
been suddenly suppressed, quiets the nervous per- 
turbation, relieves the tympanites and the tenesmus, 
"^vhether vesical or rectal, and frequently cuts short 
the attack." The tongue-indication Dr. Hale gives 
for it — red-streaked down the centre, with yellow 
sides — has been warranted by practice ; but the 
Jiard pulse of which he speaks is precisely opposite 
to that physiologically produced by the drug. 

III. In my last edition of my PJiarmacodyiiainics 
I have said the best I can say of Arsenic as an anti- 
pyretic. I have traced its history in this capacity, 
shewing that only in the malarious fevers has its 
remedial power been discovered by the empiricism of 
traditional medicine, and that even here its present- 
day revival has come from homoeopathic sources ; 
while any application of it to the hectic and typhous 
forms of fever is homoeopathic ab initio. I have 
shewn that it is unmistakably febrigenic, — indu- 
cing in some persons that peculiar morbid condition 
of the nervous centres which shews itself in recur- 
ring febrile paroxysms (which are often periodic); in 
others, a persistent febrile state which has been seve- 
ral times compared to and even mistaken for typhus. 
In virtue of the former action, I have claimed for the 
law of similars its undoubted power over ague, and 
have urged therefrom its usefulness in such hectic 
phenomena as characterise tuberculosis and pyaemia. 
On the strength of the latter, I have propounded it 



ARSENIC. 125 

as the great remedy, not only for typhus itself, but 
whenever the well-known " typhoid " symptoms occur 
— the prostration, the pallor, the fuliginous tongue 
and lips, the (often involuntary) diarrhoea. Whenever 
these phenomena appear, I have said, whether in 
the continued fevers or the exanthemata, whether 
as symptomatic of mortification or as results of blood- 
poisoning, Arsenic is our main reliance, and should 
be used freely and persistently. 

In these doctrines I have only given expression to 
the consenstLS of the homoeopathic school. Connect- 
ing the facts with our present line of thought, I 
think we may say that Arsenic excites fever by act- 
ing on both factors of the process, — by disordering 
the nervous control over the temperature, and by 
increasing heat-production in some portion of the 
body. Looking farther in search of this portion, I 
think I shall carry you with me in suggesting it to 
be the blood. The power of Arsenic to destroy the 
life of the circulating fluid has long been inferred 
from the phenomena of poisoning by it, and now has 
been established by computation of the number of 
the corpuscles before and after its influence is set 
up. Hyperoxidation of no ordinary degree is here 
apparent, and there must be a corresponding rise in 
temperature. We take our stand on these facts in 
claiming for homoeopathy the recent employment of 
the drug in pernicious anaemia (which, I may note, is 
generally accompanied with febrile phenomena) : we 
may also use them in interpreting its action as an 



126 PYREXIA AND THE ANTIPYRETICS. 

antipyretic. It is above everything toxcEinia which 
indicates it in fever : in proportion as the 

" life of all the blood 
Is touched corruptibly " 

is its control exerted. 

The use of Arsenic in typhoid conditions is a piece 
of homoeopathic practice which has not yet been — 
what shall I say .'^ ''the wise convey it call" — not 
yet " discovered " by the followers of traditional medi- 
cine. Dr. Ringer, however, has made a beginning 
of its employment in the hectic type of fever in 
which he will doubtless find many followers. (He 
had been to some extent anticipated in France, as 
by Trousseau and Isnard ; but I speak of England.) 
*' It is stated " he writes in the tenth edition of his 
Therapeutics " that arsenic will reduce the tempera- 
ture in tuberculosis, and after carefully investigating 
this subject, I am inclined to believe so ; at least I 
have frequently observed a steady and sustained fall 
of the thermometer follow the use of arsenic in cases 
where the undue temperature had continued un- 
changed for a considerable time, and this I have 
known happen twice or three times in the same 
case on reverting to arsenic after it had been discon- 
tinued. The decline generally takes place gradually, 
and may begin soon after taking the drug, or the fall 
may be postponed for ten or twelve days." The 
gradual diminution of the pyrexia, here noted, is an 
important and valuable feature in the action of our 
present drug, and applies equally to the typhoid 



CINCHONA. 127 

types of fever. It produces no sudden deferves- 
cence, as the cold bath and the large dose of quinine 
or digitalis may do. These act on the high tem- 
perature solely, leaving its cause untouched ; and 
their effects are as evanescent as they are rapid. 
Arsenic goes down to the very furnace where the 
preternatural heat is being generated, and there 
gradually but permanently extinguishes the fire. 

The double action of Arsenic, — corresponding 
on the one hand to such fevers as the malarial, the 
hectic of phthisis and marasmus, and the pyaemic, on 
the other to those of typhoid character, — this, I 
say, gives it two kinds of analogues. In the former 
sphere, it finds allies in bark and its alkaloids ; in the 
latter, in the serpent-poisons. 

I. The relation of CincJiona bark to the malarious 
fevers is still a moot one ; and the question has en- 
tered on another stage during the last ten years. On 
the one side evidence has accumulated in favour of 
malaria consisting in a contagimn vivjiin : on the other 
quinine has been proved to be one of the most potent 
protoplasmic poisons we possess. The inference is 
natural, that it cures ague by destroying its cause ; 
that it checks the multiplication in the blood of the 
germs whose inhalation has caused the mischief. If 
this be so, the rationale of its action is the same as 
that suggested by Hahnemann for the power of cam- 
phor over cholera ; and we have an explanation of the 
substantial dosage which either remedy seems to 
require. Veratrum and Cuprum will play their part 
in cholera even in high attenuation, while camphor 



128 PYREXIA AND THE ANTIPYRETICS. 

must be given in its primary solution and gains (as 
Dr. Rubini has shewn) by making this a saturated 
one. Those who treat intermittents with potencies 
seem never to use quinine and rarely its matrix bark, 
which Hahnemann maintained to be homoeopathic to 
and declared to be specific for any recent malarious 
fever occurring in otherwise healthy persons. The 
inference is that their dosage is at fault ; and that by 
using the drug in more appreciable quantities they 
would get as good results with it as others claim. 

But the analogy extends yet farther. Camphor- 
poisoning exhibits cold and collapsed conditions very 
like those of cholera : it is therefore truly homoe- 
opathic to the condition there present, and may 
benefit otherwise than as a germicide, as well as in 
similar states occurring independently of the Asiatic 
scourge. And so it is with bark. In the work to 
which I have referred I have shewn by numerous 
citations from unquestioned sources, that cinchona 
and quinine have the power of exciting in the healthy 
the febrile paroxysm. Whatever, therefore, they 
may do in intermittents by killing the malarial 
bacilli, so far as they influence the livmg tissues it 
is in a direction similar to that of the disease, and 
thus (as we know) antidotal to it. They may accord- 
ingly cure agues — as they often must have done — 
without acting as germicides at all ; and they will be 
applicable to similar paroxysms not owning malaria 
for their source. In this way they take place as anti- 
hectics. This is the type of fever liable to be set up 
when suppuration is proceeding, or any great drain 



THE SERPENT POISONS. 1 29 

on the system is going on, and this — in homoe- 
opathic practice — is the recognised sphere of our 
*' China." It is only a step farther when we come to 
the pyaemic and septicaemic fevers. Quinine may 
possibly do something here as a represser of the too 
exuberant cell-life which is overwhelming the organ- 
ism ; but I am sure that it also acts, in doses too 
small for such purposes, as a supporter to the invaded 
system. In such cases its combination with Arsenic, 
in the form of Chininum arsenicosum, is a valuable 
remedy, — the haematic action of the Arsenic rein- 
forcing the purely neurotic one of the Cinchona. 

2. Here, however, we have come to toxaemic fe- 
vers once more, and to the other branch of arsenical 
analogues, the serpent poisons. The use of these 
in medicine is peculiar to homoeopathy, and consti- 
tutes one of its most potent instruments. It should 
be so according to the law of similarity, for what is 
more quickly fatal, more widely destructive, than 
the bite of a venomous snake ? and practice has con- 
firmed the inference. In LacJicsis and Crotahis — 
the venoms respectively of the lance-headed viper 
and the rattlesnake — we have antidotes to the worst 
fevers that afflict humanity ; and the names of those 
who have done most to emphasise their value or sup- 
ply materials for their employment, the names of 
Hering, Neidhard, Dunham and Hay ward, will (I 
venture to predict) stand on lasting record. 

The phenomena of snake-bites would suggest that 
it is in malignant local inflammations, with secondary 
blood-infection and nervous prostration, that serpent- 



130 PYREXIA AND THE ANTIPYRETICS. 

venom would play its part as a remedy ; and this 
indeed has proved the great sphere of Lachesis. 
Traumatic gangrene, malignant pustule, dissection- 
wound, and all cases of pyaemia and septicaemia own- 
ing a local source, come within its range and respond 
to its action. But experiments in inoculation have 
shewn that the rattlesnake venom, at any rate, is ca- 
pable of setting up a primary pyrexia, most analogous 
to the scourge of your Southern States, the yellow- 
fever. The brilliant comparative success which homoe- 
opathy has always scored in the treatment of this 
disease — and never more so than in the last epidemic 
— has been largely due to Crotalus. But the analogy 
leads us to apply it to purpuric febrile states in gen- 
eral, whether occurring primarily and ordinarily, as 
in epidemic cerebro-spinal meningitis, or constituting 
a distinct variety or occasional form of other maladies, 
as scarlatina and variola. Dr. Hayward's monograph 
on Crotalus, which will shortly appear, is likely to 
give a great impetus to this use of the medicine. He 
can say — " for the last ten years the present writer 
has used Crotalus in all cases of fever of all kinds 
when any thing of a haemorrhagic or putrescent char- 
acter has been exhibited, and with the most prompt 
and marked effect in removing the haem.orrhagic 
symptoms and checking the tendency to putrescence." 
His two cases of malignant scarlatina (to which even 
the Lancet has given insertion) well illustrate its 
power to rescue from almost imminent dissolution. 

IV. We are now well-furnished with medicines 
which cause fever by wasting the nervous centres 



BRYONIA. 131 

and the blood ; but we want another set which shall 
serve us when the morbid process is seated in the 
more lowly-organised tissues, in those of the vegeta- 
tive system. The type of such medicines is Bryonia. 

The earliest pathogenesis of this drug appeared in 
the second volume of the first edition of the Materia 
Medica Pitra, i.e. in 18 16, and it contains — especially 
in the portion furnished by Hahnemann himself — 
some marked fever-symptoms. It is probable that 
he had observed these some time previously, for as 
early as 18 13 he had been led to give Bryonia as one 
of the chief remedies in the epidemic fever which 
ravaged the army that had fought at Leipsic. On 
reading his account of the matter (which you will 
find in Dr. Dudgeon's translation of his lesser writ- 
ings), you will see that the symptoms which — in 
addition to the common febrile ones — led him to its 
choice were "shooting (or jerking-tearing) pains in 
the head, throat, chest, abdomen &c., which are felt 
particularly on moving the part." These express its 
action on fibrous, serous and muscular tissues. When 
delirium supervened — when, that is, the hyperoxi- 
dation involved the nervous centres — Hyoscyamus 
had to take its place. 

Now it was obvious that if pains increased on move- 
ment were to be the characteristic of the Bryonia 
fever, it should be above all things a remedy in acute 
rheumatism ; and so it has proved to be, as we shall 
see in our next lecture. But if, so indicated, it could 
control the whole febrile condition present, it must 
evidently play some part in the treatment of the 



132 PYREXIA AND THE ANTIPYRETICS. 

essential fevers, of which that treated by Hahnemann 
was an instance. It was possibly (as Dr. Russell 
thinks) of the kind now known as " relapsing," though 
I do not find any mention of relapses as occurring in 
it.' The success he reported with it, and some addi- 
tional symptoms given in the second and third edi- 
tions of his Materia Mcdica Pura^ led to its taking 
among his followers a high place among the reme- 
dies for the common endemic "typhus," which was 
generally that which we now call typhoid or enteric 
fever (their "typhus abdominalis "), but sometimes 
the "synoque" of the French, the "gastric" or 
" common continued " fever of our English nomen- 
clature. All the representative writers of the first 
period of homoeopathy — Hartmann, Wolf, Trinks — 
concur in stating that the fever of Bryonia is a syn- 
ochus, often so active as to simulate a synocha, and 
so (wrongly) to call for Aconite, but liable, if not 
checked, to go on to a typhus nervosus. Such a 
condition — vascular and nervous erethism, without 
much prostration — we often have at the commence- 
ment of true typhoid, but still more in the initial 
stage of the common continued fevers. To these it is 
probable that (as with Baptisia) Trinks' statement 
applies that typhus may sometimes be arrested with 
Bryonia. The features in them which have led to 
the appellation "gastric" are further indicative of 
our present medicine ; for such symptoms as coated 
tongue, foul and bitter taste, nausea and vomiting, 

' In this " famine fever " Dr. Kidd, who saw so much of it in Ireland in 
1847, considers Bryonia the best medicine. 



RHUS. 133 

and so forth, — which have not come before us in the 
fevers of Aconite, Belladonna, and Arsenic, are 
always strong indications for Bryonia. Let head- 
ache and other pains be further marked, and a ten- 
dency to involvement of the chest appear, and we 
have a pyrexia which Bryonia will arrest if arrestable, 
and at any rate will modify so favourably as to earn 
the patient's grateful thanks. 

The allies of Bryonia are Rhus, Phosphoric and 
Muriatic acids, and Baptisia. 

I. From their first joint appearance in the volume 
of the Materia Mcdica Pura issued in 18 16, Bryonia 
and RJins have ever gone together ; and these *' great 
twin-brethren " have come to our aid in many a 
doughty fight. Rhus also had been found to excite 
decided febrile symptoms, not merely as sympathetic 
with the dermatitis caused by its external application, 
but primarily, from ingestion in moderate doses. 
Hahnemann accordingly administered it in the fever 
I have already mentioned, either after Bryonia, or 
from the outset, when the pains were worse during 
rest, and when greater prostration was present. 
Whatever this fever was, of 183 cases treated by 
him in Leipsic not one died ; and so Rhus, like 
Bryonia, became a fever-remedy in the homoeopathic 
school. Hahnemann himself resorted to them, as 
the standard febrifuges, in the consecutive fever of 
cholera, apparently recommending their alternation 
therein. In the common continued fevers — gastric 
and typhoid — the question has generally been which 
of these should Ke given ; and Rhus has been recog- 



134 PYREXIA AND THE ANTIPYRETICS. 

nised as suitable to an erethistic condition more 
adynamic than that of Bryonia, but less so than that 
of Arsenic. The first supervention of diarrhoea 
upon constipation, of a red upon a coated tongue, 
calls for it in gastric fevers ; and in true typhoid may 
often indicate it from the first. ^' Comparing it " 
writes Dr. Dunham " with Bryonia and Eupatorium, 
we miss at once the whole train of gastro-hepatic 
symptoms, the vomiting of bile, soreness and pain 
.at the pit of the stomach, constriction around the 
epigastric zone, fulness and tenderness of the hepatic 
region, etc., which indicated those remedies in bil- 
ious remittent fevers. On the other hand, we find 
Rhus producing some degree of tenderness of the 
abdomen, great flatulent distension of the abdomen, 
amounting to tympanites, occasional watery or mu- 
cous diarrhoea, — symptoms which, though not so 
strongly pronounced as similar symptoms are under 
Phosphoric acid, yet decidedly resemble the symp- 
toms of typhoid fever, and indicate the use of Rhus 
in that disease." A red triangle at the tip of the 
tongue has recently been said to indicate it here. 

2. PJiospJioi'ic acid was reckoned by Wurmb and 
Caspar, the distinguished clinicians of the Leopold- 
stadt Hospital in Vienna, an analogue of Rhus in 
typhoid, corresponding to symptoms of the same 
degree of severity, but marked by torpor rather than 
erethism. How they came so to use it I cannot tell ; 
for there is little indication of fever in its pathogen- 
esis, and neither Hahnemann nor any of his earlier 
disciples mention it in this connection. Dr. Dun- 



MURIATIC ACID. I35 

ham, however, as we have seen, seems to think the 
indications warranted ; and they are confirmed by 
the high value set upon it by the no less eminent 
Paris clinician, Dr. Jousset. "Phosphoric acid" he 
writes " is, with Muriatic acid, one of the principal 
medicines for typhoid fever in its stage of full devel- 
opment : abundant diarrhoea with involuntary stools, 
paleness . of the stools, but most of all intestinal 
haemorrhage, indicate the remedy. As concomitant 
symptoms we observe epistaxis, bleeding of the 
gums, pallor of the face or one cheek red and the 
other pale." 

3. With Phosphoric goes Muriatic acid ; and, to 
my thinking, outdoes it far in range and energy in 
the febrile sphere. Our employment of it here must 
indeed be traced to tradition ; for the fever-symptoms 
of Hahnemann's pathogeneses of the drug are quite 
insignificant. The tradition took its rise from iatro- 
chemistry : the chlorine and the acid were supposed 
to neutralise respectively the putrescence and the 
alkalescence of the fluids in low febrile states. 
That the action Avas really dynamic appears from the 
high esteem in which it has been held in the homoeo- 
pathic school, when given in doses far too small to 
exert any other kind of influence. The tendency 
to ulceration of mucous membrane observed in cases 
suitable for it suggests that it is where the hyper- 
oxidation of fever affects chiefly this tissue that it 
is most applicable ; and it gives it a special relation 
to typhoid. Putrescent phenomena, with us as of 
old, are always indicative of it ; and it thus fre- 



136 PYREXIA AND THE ANTIPYRETICS. 

quently finds place in the treatment of malignant 
scarlatina and diphtheria. 

4. Last, but not least, I have to speak of Baptisia. 
The question of the power of this drug to abort true 
typhoid is, I think, definitively closed. There are 
occasional instances of this fever which spontane- 
ously terminate at an early period, and any one who 
uses Baptisia much for it will every now and then 
meet with such a case. If he ignores the numerous 
examples of the malady in which no such result has 
followed, he may become an advocate of its abortive 
power here. But whenever a succession of cases of 
true typhoid has been submitted to the treatment, 
the result has always been failure. 

There is, however, a fever in which Baptisia is 
specific, and whose course it does positively arrest. 
This is the "gastric," or common continued fever of 
which I have already spoken, — a fever which runs 
no definite course, but which, under ordinary treat- 
ment, mostly puts on a typhous appearance before 
coming to its close. That Baptisia is the Aconite 
of this fever, that it can break it up in perspiration 
in (at most) two or three days, is a thing of which I 
am as certain as of anything in therapeutics. It was 
the confusion of this fever with true typhoid which 
led to the baseless claims some of us (among whom 
I must include myself) have made for the remedy ; 
but we must not, in the re -action, abandon it alto- 
gether. Such a malady is often seen, is sometimes 
epidemic, — it constitutes the "colonial fever" of 
Australia and the Cape ; and the fame of Baptisia 



BAPTISIA. 137 

in the past, and its solid usefulness in the future, 
lie within the sphere of it. 

With Baptisia, as with Muriatic acid, putrescent 
phenomena are characteristic ; and foetor of the 
breath and secretions alike indicates it and yields to 
its use. It may thus play a part in other fevers 
where such a feature is apparent, in scarlatina, in 
diphtheria, and above all in variola. Dr. Eubulus 
Williams' experience with it in the last-named, dur- 
ing an epidemic occurring in a children's home at 
Bristol, was strikingly favourable ; and he especially 
notes the absence of the usual offensive effluvia in 
the cases treated by it. 

We have yet to learn what it is in suppuration 
which causes hectic, and it may well be some pro- 
cess allied to putrescence. Dr. Mitchell, of Chicago, 
has praised Baptisia highly in this fever when occur- 
ring in connexion with phthisis ; and I have verified 
the indication when the tongue has been moist and 
coated, instead of — as in the cases calling for Ar- 
senic — red and apt to become dry. 

These, ladies and gentlemen, are the leading classes 
of our antipyretics, and the drugs that fall within 
them. The groups now formed and comparisons 
instituted will aid you, I trust, to apprehend more 
clearly their genius and sphere of usefulness, and so 
to employ them with enhanced precision in the vari- 
ous febrile states which come before you. Rightly 
used, they will give you — I believe — such control 
over fever that you will need none of the harsher 



138 PYREXIA AND THE ANTIPYRETICS. 

measures of the old school to supplement them. A 
temporary exception must be made for the sudden 
hyperpyrexia of which I have spoken, where accord- 
ing to our present knowledge the cold bath or pack 
is indispensable for the saving of the patient's threat- 
ened life. Save under these rare circumstances, 
however, homoeopathic medication, with ordinary 
coolness and quiet, abundant drink, and simple regi- 
men, will form the best of antipyretic treatment. 



VII. 

RHEUMATISM AND THE ANTI-RHEUMATICS. 

In taking Rheumatism as the second peg on which 
to hang a bundle of medicines, I am aware that I am 
assuming that to be an entity which pathology refuses 
so to recognise. The numerous affections known as 
** rheumatic", ranging from acute polyarthritis to a 
simple stiff-neck, have — it is said — neither a com- 
mon specific cause nor a single anatomical seat : al- 
ready a number of them have been differentiated as 
gout, rheumatoid arthritis, myalgia, &c., and the re- 
mainder hold their place provisionally only. But, 
whatever may be said theoretically to such criticism, 
it still holds good practically that around the true 
"rheumatic fever" which all agree is an ''essential" 
malady there are grouped a number of affections more 
or less closely allied to it, owning (mostly) the same 
atmospheric causation, occupying similar parts, and 
— which to us is of most importance — responding 
to similar medicines. I maintain that these are as 
much entitled to the term "rheumatic" as is the 
febrile polyarthritis specially so named, and I shall 
include them as varieties of the malady of whose 
remedies I have now to speak. 

139 



140 RHEUMATISM AND THE ANTI-RHEUMATICS. 

By rheumatism, then, we mean first of all the 
acute general form — "rheumatic fever." As the 
name implies, fever is a marked feature here : it 
even seems to precede the affection of the joints, 
though — as in pneumonia — the appearance may be 
deceptive. It is admitted by all to be proportionate 
to the number of the joints involved and the inten- 
sity of their inflammation. It has the curious feature 
of being accompanied almost from the outset by free 
perspiration, which, however, affords no relief ; and the 
sour odour of the sweat is known to all who have at- 
tended a case of the kind. It is in acute rheumatism 
that the temperature is most apt to run up to that 
menacing height in which it is known as " hyper- 
pyrexia." This, however, must not be regarded as an 
excessive degree of the true rheumatic fever, which 
is an inflammatory one : it is confessedly rather of 
neurotic origin, and referable to a collapse of the 
heat-controlling centres in the cerebro-spinal system. 
The inflammation is primarily situated in the syno- 
vial membrane of the joints, — though it may spread 
to the neighbouring parts ; and it is characterised by 
great instability, suddenly supervening and as sud- 
denly departing, the (purely serous) effusion being 
as rapidly poured out and re-absorbed. Certain sec- 
ondary inflammations are very apt to occur during 
the course of the disease, viz. : peri- and endo- carditis 
and pleurisy, less frequently meningitis and pneu- 
monia. That the serous membranes should be spe- 
cially affected their close alliance with the synovial 
would make appropriate ; but it is to be noted that 



MATERIES MORBI OF RHEUMATIC FEVER. 14! 

when inflammation attacks these in the course of 
rheumatic fever, it is not fugitive as in the joints, 
but takes a firm hold, and — especially in the heart 
— often leaves lasting results. 

The cause of this disorder is in most cases a chill, 
less frequently a fright, occurring to persons heated 
by exertion ; in either case checking perspiration. 
It is reasonably inferred that its phenomena are due 
to the retention in the blood of excrementitious 
products, capable of setting up local inflammations 
and general fever; and that the sweating of the dis- 
ease is an eliminative effort, its odour being due to 
the acid nature of the niaterics morbi. In the rare 
cases in which rheumatic fever developes spontane- 
ously, we may suppose that the same products have 
resulted from mal-assimilation or imperfect retro- 
grade metamorphosis. 

Whether this theory be true or not is of some 
therapeutic importance. In the first place, it rules 
the application we shall make of Dr. Balthazar Fos- 
ter's two observations (confirmed by one of Kuelz's) 
that the administration of lactic acid — at any rate 
to diabetic patients — is liable to set up acute rheu- 
matic arthritis in various places ; while Richardson 
and Ranch have found it, in animals, capable of in- 
flaming the endocardium. By our law, lactic acid 
should be a prime remedy for rheumatic fever, if it 
were not — as it is by the hypothesis just stated — 
the v^ery niaterics viorbi. Certainly no reports of 
success with it have appeared in homoeopathic litera- 
ture ; and their absence favours the other alternative. 



142 RHEUMATISM AND THE ANTI-RHEUMATICS. 

If it be true, the present supplies illustration of the 
impossibility of always working with symptomatic 
resemblances only, and ignoring pathology. 

But then, if lactic acid in quantity be the pyro- 
genous and phlogogenous matter of rheumatic fever, 
is not chemical antidotal treatment — as by alkalies 
— indicated therein ? It is difficult to resist the 
inference theoretically, and practically it has been 
maintained that not only is the whole duration of the 
malady lessened by such treatment, but — which is 
more important — the frequency of cardiac complica- 
tion is materially abated. The objection to such 
treatment lies in its flooding the system with the 
necessarily large quantities of alkali required,' — an 
evil somewhat mitigated by substituting salts of soda 
for those of potash hitherto given, but generally re- 
sulting in greater anaemia than is natural during con- 
valescence. The total outcome of experience with 
alkalies has not hindered our brethren from grasping 
eagerly at the prospects held out by salicin and the 
salicylates, nor has it stood in the way of trimeth- 
ylamine or dethroned colchicum. These last are 
remedies which act like our homoeopathic specifics, 
striking, as we may suppose, at the cause rather than 
neutralising an effect. For, although the starting- 
point of rheumatic fever may be the retention of 
lactic acid in the blood, from checked perspiration, 
its persistence for weeks must imply (as such a 
product has no self-multiplying power) a continual 

^ " No effect can be expected from alkalies unless tliey are given in very 
large doses " (^Senator, loc. cit.). 



ALKALIES IN RHEUMATIC FEVER. I43 

fresh formation of the viateides morbi ; and here we 
must hypothecate a morbid protoplasmic activity, 
by the cessation of which alone can the disease be 
radically cured. 

In adults, at least, we are therefore warranted in 
relying solely on specific measures. In young peo- 
ple, viewing the much greater frequency of heart- 
affections, and the apparent efficacy of alkalies to 
avert them, their administration would be desirable, 
were we not capable of achieving as good results 
with purely homoeopathic treatment. It would also 
appear, moreover, that it is only in comparison with 
other perturbative treatment — as by blisters, opium, 
&c. — that alkalies secure this superior innjiunity ; 
since cases left to nature under good nursing *do as 
well. I am not sure, however, whether the experi- 
ment has been carried out on a sufficiently large 
scale, and whether — as with Dietl's in respect of 
pneumonia — a greater number of cases might not 
alter the averages. 

But we must return to our clinical survey. Chronic 
articular rheumatism is allied to rheumatic fever by 
being not uncommonly its sequela ; and, when it is 
of primary occurrence, by its resulting from the same 
causes, viz. : continued exposure to cold and damp. 
It is more fixed in seat, and leads to greater changes 
in the substance of the joints : otherwise, it may be 
described as consisting of the local affection of acute 
rheumatism without the constitutional disturbance. 

" Muscular rheumatism " is a good deal discredited 
now-a-days ; and, when not of systemic origin (as in 



144 RHEUMATISM AND THE ANTI-RHEUMATICS. 

scurvy and metallic poisoning), is set down as either 
myalgia or myositis. I cannot think this procedure 
wise. The true "myalgia" ought — I think — to 
be restricted to muscular pain coming on after too 
prolonged, sudden, or great exertion ; while myositis 
can hardly be present without tenderness of the in- 
flamed muscle, — a symptom of which in the acutest 
cases of lumbago there is hardly any trace. The 
majority of instances of this malady, of pleurodynia, 
and of torticollis, can be traced to the main causes 
of rheumatism generally, and may fairly therefore be 
considered " rheumatic " in their nature. 

Again, the fibrous tissues throughout the body, 
especially the fasciae and nerve-sheaths, are, under 
similar circumstances, liable to acute or chronic mor- 
bid conditions whose pain, stiffness, and sensitiveness 
to atmospheric changes assimilate them to rheumatic 
arthritis. They too may therefore be considered 
part of our disease-group, and will be found to have 
a very defined relation to certain anti-rheumatic 
remedies. 

To these we now proceed. 

I. Bryonia, of all medicines, comes nearest to 
being a typical analogue of rheumatism, in almost 
all its forms. It is a specific irritant ; and the parts 
it inflames when absorbed into the blood are, not so 
much skin and mucous membrane, as serous and 
synovial membrane, fibrous tissue, and muscle. It 
has excited, especially in one of the heroic Austrian 
provers (W. Huber), decided fever ; and in several 
of them the urine was of febrile character. Hahne- 



BRYONIA. 145 

mann and Otto Piper have each noticed sour sweat 
from it. As regards the joints, a number of the 
symptoms of its pathogenesis (see S. 1345, 1425, 
1426, 1550 and 155 1 of Allen's EncyclopcEdia) speak 
of swelling, stiffness and tenderness in them ; and 
a very instructive experiment was made on himself 
by Dr. Elias Price, of Baltimore, who, after taking 
doses of the tincture ranging from 30 to 50 drops, 
had — after five days' incubation — a decided attack 
of rheumatism of the foot, not entirely passing away 
until seven weeks had elapsed. F'or the muscles, 
we have soreness and pain on motion experienced 
by the provers in many parts of the body, even to 
the production of pleurodynia and lumbago ; and in 
an autopsy made on an animal poisoned by it, the 
substance of the heart and the muscles of the neck 
were found intensely red. 

When the rheumatic significance of the patho- 
genesis of Bryonia was first noticed, I do not know. 
Hahnemann does not intimate it ; but Hartmann, 
in 1839, speaks of it as already '' a very celebrated 
remedy." Curiously enough, popular practice had so 
far anticipated its applicability to joint affections as 
to give it the name of Gicht-riibc, gout-root. What- 
ever it may do for the malady referred to in this 
appellation, there is no doubt that in the treatment 
of rheumatic affections of all kinds it plays a most 
important part. In rheumatic fever, some of us 
alternate it with Aconite throughout — Dr. Yeldham 
advising the one to be given during the day, the 
other at night : some prefer to give Aconite alone 



146 RHEUMATISM AND THE ANTI RHEUMATICS. 

until it has done all it can do, and then to put in our 
Bryony. There are two indications, however, which 
should lead us to administer Bryonia by itself and 
at the first. One is pathological : it is when the 
disease presents the '' synovial " as distinct from the 
"fibrous" form. This distinction was made by 
Chambers and Francis Hawkins, and has been en- 
dorsed by Watson. In the synovial variety there is 
more local swelling and less general fever : as the 
name implies, the synovial membranes of the joints 
are the seat of the inflammation rather than the 
tendons, fasciae, and ligaments round about them ; 
and we have seen that it is these chiefly on which 
our medicine acts. The other indication is symp- 
tomatic : it is where the sensitiveness to movement 
so characteristic of the drug is markedly present. 
In proportion to its degree not only is Bryonia called 
for, but its dosage becomes more attenuated, so that 
from the. 1 2th to the i8th, or even higher, it displays 
the most brilliant powers, as testified to — inter alia 
— by Bayes ancl Madden. I mention this, because 
generally in rheumatic affections the lowest dilutions 
seem to do most good. In the complications of 
rheumatic fever, Bryonia is quite competent to deal 
with the pleurisy and the pneumonia ; but when the 
heart becomes affected it yields place to more defi- 
nitely cardiac remedies. In chronic articular rheu- 
matism Bryonia occupies a sphere which may be 
exhibited in the words of Sir Thomas Watson : — 
"There are two kinds of chronic rheumatism: one 
attended with local heat and swelling, although the 



BRYONJA. 147 

constitution at large sympathises very little or not at 
all with the topical inflammation ; the other charac- 
terized rather by coldness and stiffness of the joints. 
In the former of these the pains are increased by 
pressure, and by movements of the limbs, and by 
external warmth ; the warmth of a bed, for example ; 
and there may be even some slight degree of pyrexia 
at night. In truth this form of chronic rheumatism 
claims a near relationship with the acute, into which 
it sometimes passes, and of which it is frequently 
the sequel." I may anticipate so far as to say that 
the great remedy for the second variety here de- 
scribed is Rhus, but for the first Bryonia is specific. 
In acute muscular rheumatisms it also plays an im- 
portant part, though in severe lumbago I confess I 
prefer Aconite. The pain on movement of our medi- 
cine is of course present here to a marked degree ; 
and in pleurodynia where it is indicated it obliges the 
patient to lie on the affected side. For the chronic 
fibrous rheumatisms Bryonia can do little. It is to 
maladies caused by dry cold, such as that brought 
by the east winds of my country, sweeping across 
the arid steppes of Russia, and traversing no ocean 
of any breadth which can temper their harshness, 
that this remedy is appropriate ; while the affections 
in. question trace their origin rather to cold associ- 
ated with damp. 

Bryonia, in its relation to rheumatism, may fairly 
be regarded as the head of a group of medicines ; 
the other members of which are Aconite, Colchicum, 
Pulsatilla, and the product variously known as "pro- 



148 RHEUMATISM AND THE ANTI-RHEUMATICS. 

pylamine " and '' trimethylamine." To these we will 
now direct our attention. 

I. Next to Bryonia, our great anti-rheumatic is 
Aconite. Here we have not been, as with the other, 
the first to establish its virtues. Stoerck, in 1750, 
experimenting on himself with the extract, found it 
to cause considerable diaphoresis. He inferred that 
it should prove useful in chronic local rheumatisms, 
and found it so to be, the improvement generally 
setting in with sweating and eruptions on the affected 
parts. From this the transition to acute local rheu- 
matisms and at length to rheumatic fever was natu- 
ral : Tessier (of Lyons), Lombard and Fleming were 
its agents, and you will find in Stille several other 
testimonies to its value. Nevertheless, the remedy 
has not occupied the place which might have been 
expected in ordinary practice ; and I agree with Dr. 
Phillips that this has resulted mainly from the strong 
doses in which it has been given. The aim has been 
rapidly to hush up the pain in the joints or to knock 
down the fever : this the drug can only do as an 
anaesthesiant and arterial sedative, and its effects 
when thus given are so unpleasant and even danger- 
ous that its use comes to be abandoned. 

That so it is appears from the steady favour ac- 
corded to it in the school of Hahnemann, where 
gentle and unperturbing dosage is practised. We 
believe it to be homoeopathic to acute rheumatism, 
and use it accordingly — absorbing its whole physio- 
logical in its therapeutical action. We conceive that 
we have good grounds for so regarding it. Li relation 



ACONITE. 149 

to fever I have brought before you only the neurotic 
action of Aconite ; but it must not be forgotten that 
it is also an irritant. You will sometimes hear it 
said that Aconite does not cause inflammation ; and 
this is true if the process in parenchymatous organs 
is intended. But in post-mortem examinations of 
animals poisoned by it decided evidences of inflam- 
mation of the pleura and peritoneum have been 
found ; and the sensations of some of the provers 
point in the same direction. Similar pains, of cut- 
ting, shooting and tearing character, were experi- 
enced by them in the fibrous tissues generally, the 
muscles, and the joints, — those in the last-named 
having been observed also in cases of poisoning. 
One of Schroff' s provers of the Aconitum camma- 
rum experienced them to a high degree. In no case, 
however, is there — as with Bryonia — any redness 
or swelling. 

Having regard to these facts, and to the relation 
of Aconite to the synocha present in this disease, 
we should say that it ought to be the prime remedy 
in the " fibrous rheumatism " of Chambers and 
Hawkins, where the peri-articular tissues are mainly 
affected and the fever runs highest. This indeed it 
is. You must not use it as a neurotic in this in- 
stance, and expect it to subdue the fever in twenty- 
four hours. It cannot here help us by liberating the 
arterioles from their contracted state, and promoting 
heat-radiation. This is going on abundantly, but 
heat-production is on its side so greatly enhanced 
that no relief is gained thereby. In rheumatic fever 



150 RHEUMATISM AND THE ANTI-RHEUMATICS. 

Aconite is rather antiphlogistic than antipyretic : it 
acts on the protoplasm which is being too rapidly 
oxidised, and for this time is required. 

It is the testimony of all who have trusted to 
Aconite in acute rheumatism that under its use the 
heart is much less liable to be affected. Should it 
be so, however, you need not intermit the use of the 
drug ; for its homoeopathicity and activity here have 
been abundantly proved. " One of the Austrian 
provers had, alternating with his articular suffer- 
ings, painful palpitation of the heart and praecordial 
anxiety ; and Dr. Jousset says that he has intro- 
duced into the circulation of rabbits increasing doses 
of the extract, with the invariable result of pro- 
ducing lesions of the mitral valve " {PJiarinacody- 
iiainics). If Aconite is actually being taken when 
the cardiac complication supervenes, it may be alter- 
nated with another heart-medicine, as Spigelia ; but 
otherwise it may be given alone, and relied on alone. 

In our dosage. Aconite has hardly found place in 
the treatment of chronic rheumatism, articular or 
fibrous ; and in acute muscular rheumatism it gen- 
erally gives way to Bryonia or Cimicifuga. I would 
make an exception, however, in the instance of lum- 
bago. It caused a real attack of this nature in 
Schneller, a physician of the old school who proved 
it at Vienna in 1848, and I have always found it 
very effective as a remedy. Here, however, as in 
rheumatic affections generally, you must not — I 
believe — attenuate the drug too far. I seldom rise 
above the ist decimal dilution, and generally give 
drop-doses of the tincture. 



COLCHICUM. 151 

2. The second of the analogues of Bryonia is 
CokJiiciivi. The repute of this medicine has mainly 
been acquired in the treatment of gout ; but Watson 
is not the only physician who declares of acute rheu- 
matism, that "the preparations of colchicum have 
sometimes an almost magical effect in subduing the 
disease." When we enquire how they act, we find 
that it is by no indirect process, for it is quite un- 
necessary to induce the purgative operation of the 
drug : nor is it by any antiphlogistic power, since in 
ordinary inflammations — not being gouty or rheu- 
matic — it is quite inert. The action is direct and 
specific ; and to account for it we can only look to 
the physiological effects of the plant. Let us take 
a case of poisoning by it, reported in the London 
Medical Gazette for 1838-9. A woman, at 33, took 
nearly an ounce of the tincture of the seeds one 
Thursday at 11 p.m. Symptoms of gastro-enteric 
irritation soon supervened ; but among these, about 
10 A.M. on the Friday, she felt a numbness of the 
feet and hands. "To this succeeded" writes the 
reporter " a pricking feeling, as if, so she expressed 
it, they had been asleep. All the joints of the 
fingers and toes, and also the wrists and ankles, 
were very painful, and the toes and fingers were 
painfully flexed at times. Pain in the shoulder-joints 
succeeded, and, on Saturday, in the hips and loins. 
It was also increased in intensity, so that she said 
she thought she should go mad. Ultimately, almost 
all the bones and joints were affected with pains, 
which were of a gnawing, dragging character. Just 



152 RHEUMATISM AND THE ANTI-RHEUMATICS. 

before these symptoms were at the height, very pro- 
fuse sweats came on, and were of a very sour odour. 
I may mention, that to the pains in the hmbs were 
added, on Sunday morning, great stiffness and pain 
in the back of the neck and occiput, which was 
aggravated by moving the head : there was also a 
feehng as of something tightly bound round the 
head ; and on moving the tongue, and in swallowing, 
she experienced sharp pain about the root of the 
tongue. She asked me if she had not got rheumatic 
fever. . . . The pain in the joints continued exceed- 
ingly severe long after the vomiting and purging had 
ceased : it was still so on Tuesday." 

These effects are paralleled at points in several 
of the numerous provings which have been made 
with the drug, both in the old school and in our 
own ; though here perhaps the pains have been felt 
more in the muscles than in the articulations. Two 
other observers, however (Krahmer and Lindemann), 
have noticed the sour sweats so characteristic of 
rheumatism ; and in a boy who had eaten portions 
of the plant the left elbow and knee-joints were 
swollen, hot and painful. . The numbness and prick- 
ing of the hands and feet observed by Mr. Henderson 
(the reporter of the case of poisoning) is interesting, 
as it is a well-known effect of Aconite, and we shall 
see it again in Propylamine. 

After all this, I am sure that any candid enquirer 
would bear me out in claiming for homoeopathy any- 
thing that Colchicum can do in rheumatism. Mr. 
Henderson very justly observes that the symptoms 



PULSATILLA. 153 

of his patient would suggest that it was not by its 
purgative effects — as then supposed — that the drug 
proved remedial, but by its specific action on the 
parts affected. We have not used it much, as in 
Bryonia we have a remedy so closely resembling it, 
and taking its place in that very ''synovial" rheuma- 
tism to which it has hitherto been allotted. But the 
poisoning I have cited would suggest it as hardly less 
applicable to the ''fibrous " form, if another medicine 
seems needed after Aconite has spent its force. As 
with the two preceding anti-rheumatics, it has shewn 
a specific influence on the serous membranes by in- 
flaming the pleurae ; and it has displayed remarkable 
power in controlling pericarditis when occurring in 
the course of rheumatic fever. It should be more 
used than it is in muscular rheumatism, especially 
torticollis, as it seems to have an elective affinity for 
the muscles of the neck. It caused pleurodynia in 
several of its provers ; and in a gouty patient of Dr. 
Russell's proved strikingly curative of it. Its patho- 
genesy bears Teste out in saying that the rheumatic 
pains to which it corresponds are generally tearing. 
He adds that in warm weather they are principally 
felt at the surface of the body : as the air grows cooler 
they seem to penetrate the deeper tissues and the 
bones. 

3. The third drug to which I would draw your at- 
tention in this category is Pulsatilla. It is one which 
is still peculiar to homoeopathic practice, though our 
esteem of it in orchitis has lately received corrobora- 
tion from several practitioners of the opposite camp. 



154 RHEUMATISM AND THE ANTI-RHEUMATICS. 

Its action on the joints was manifest in Hahnemann's, 
provings of the nigricans species, and appears also in 
those which have been made in this country with the 
Pulsatilla Nuttalliana. In most of the articulations 
the pains, however severe, were transient ; but in the 
knee, and especially in the feet, they were accompa- 
nied by swelling, indicating synovial effusion. 

The general action of Pulsatilla would indicate its 
use in sub-acute rheumatism, of synovial type, with 
little or no fever; where the knees, ankles, or small 
joints of the feet and hands are affected ; and when 
the articular inflammation shifts readily from place 
to place. The temperament and disposition of the 
patient will in such rheumatisms generally be found 
that characteristic of Pulsatilla, and — when present 
— will lend additional force to its indications. Its re- 
lation to the digestive organs, moreover, would point 
to it as specially applicable when faulty assimilation 
rather than chill had evoked the disease. In chronic 
articular rheumatism the indications are the same ; 
and here its *' conditions " must be specially regarded, 
viz. : that its pains are worse towards evening and at 
night, worse also at rest and in a warm room, and 
relieved by motion in the open air. These features 
of the action of the drug we owe to Hahnemann ; and 
they are invaluable in determining its choice. On 
the fibrous tissues and muscles Pulsatilla has no ac- 
tion. 

Another relation of this medicine which must be 
remembered is that which it bears to the generative 
There is an ally of rheumatism 



PROPYLAMINE. 155 

and gout, specifically distinct (however) from either, 
variously known as " rheumatic gout," "nodular rheu- 
matism," or (better) " rheumatoid arthritis." When 
fully develoj^ed, no arthritic disease is more hopeless 
and more disabling : the best chance for its victims 
is to take it in the sub-acute form in which it not un- 
commonly begins. Now Dr. Fuller has noted that 
" in early life, rheumatic gout is always hereditary of 
connected ivith disordered nterine function ;'' and I 
would add that, in later life, its most frequent sub- 
jects are women at the climacteric period. Pulsatilla 
finds an obvious sphere of action here ; and has more 
than once justified its choice. 

4. The last drug of our present group is Propyla- 
mine, I use this name for the present, as it is that 
by which the substance in question is known in com- 
merce, under which it was first introduced into medi- 
cine, and by which it is designated in homoeopathic 
literature. It is more properly, however, trimethyla- 
mine. Methyl, not propyl, is its radical, — three 
parts of this displacing three parts of the hydrogen 
of ammonia, the resulting body being expressed as 
C3H9N. The substance used in medicine is the 
propylamine of commerce purified, — this in its turn 
being obtained from many animal products, of which 
herring-brine is one of the best known and least 
unpleasant. It is not pure methylamine — some 
ammoniacal salts almost inevitably cleaving to it ; 
but the former can be made synthetically, and — 
given as a chloride — seems to act much in the same 
way as that obtained analytically. As these prod- 



156 RHEUMATISM AND THE ANTI-RHEUMATICS. 

nets are little known, I may mention that Propyla- 
mine dissolves freely in ether, alcohol, and water ; 
and that, if you have to give it strong enough to 
make it desirable that its disagreeable taste should 
be disguised, you may accomplish this to some degree 
by adding a little peppermint. The chloride of tri- 
methylamine is equally soluble, but inodorous and 
not repulsive to the palate. 

Propylamine was first introduced into medicine 
about 1855, by Awenarius, a Russian physician, who 

— after using it in 250 cases of acute rheumatism — 
reported it as little less than specific. Giving two 
drops only every two hours, he ''frequently saw all the 
symptoms of the disease vanish after twelve doses 
had been taken." Dujardin-Beaumetz, in France,^ 
and W. H. Spencer, in England,^ have since reported 
results almost equally good ; and the remedy was 
just coming into favour when the salicylic treatment 

— of which I shall speak immediately — dethroned 
and extinguished it, so that it finds no place in the 
last edition of Ringer's or of Wood's Thcrapetttics. 

It is not our way so to lose a potent medicine, and 
it has never been forgotten in the homoeopathic 
school. We have studied it in our usual manner, 
i.e. first pathogenetically, by observation and experi- 
ment, and then therapeutically. Observations on 
patients treated by it have yielded little definite 
result as regards its physiological action. Dujardin- 
Beaumetz, however, proved the chloride of trimeth- 

1 Bull. Gen. de Ther., LXXXIV., 227, y^-j, 395. 

2 Practitioner^ Feb. and Mar., 1875. 



PROPYLAMINE. 157 

ylamine on himself and another healthy person, and 
in both the force and frequency of the pulse were 
reduced, and the temperature fell nearly or quite 
one degree centigrade. One of our own colleagues, 
Dr. Chaffee, of Kentland, reported to the Indiana 
Institute of Homoeopathy, in 1880, a proving on 
himself. ''I took" he says "ten drops of propyla- 
mine in water. One half hour after taking the same 
I experienced a smarting sensation of the tongue 
and fauces, with much thirst : there was also a tin- 
gling of the fingers, a sensation of numbness to such 
an extent that in attempting to pick up any thing it 
felt heavy, and I had to use great effort to retain the 
article within my grasp. This group of symptoms 
passed off at the expiration of three hours. I then 
took another dose of ten drops and experienced the 
above symptoms intensified, with the addition of 
great pain in the wrist joints, also great restlessness, 
yet inability to stand upon my feet from the pain 
produced in the ankle-joints. I took no more of the 
medicine, the tongue became broad and flabby, the 
mucous membranes of the buccal cavity were pale, 
appetite gone, no desire for anything, became mo- 
rose, with great desire to be let alone : the pain in 
the joints was made worse by the slightest move- 
ment. Twenty-four hours after taking the drug, I 
was attacked with diarrhoea : the stools were thin, 
watery, and white." ' 

Several casual experiences with the drug have 
been reported in our journals, and one of these may 

^ U. States Med. Investigator, June 15, 1880. 



158 RHEUMATISM AND THE ANTI-RHEUMATICS, 

be cited as worthy to stand beside those from old- 
school sources. Dr. Sanborn, of Hampton Falls, 
N.H., writes — ^ " In January, 1862, I began to use 
Propylamine in rheumatic fever, and have used it 
every year since. My whole number of cases has 
been about sixty. I begin the treatment with Aco- 
nite and Propylamine, giving two drop doses of the 
latter four times a day, I have had no case which 
lasted more than a week, and generally in three days 
my patients can walk about without pain." ' This 
very fairly corresponds with the experience of Du- 
jardin -Beaumetz and of Spencer. The latter of 
these, I should say, notes that the remedy does not 
produce such marked and speedy effects in lymphatic 
subjects as in those of nervous and sanguine temper- 
ament. It is therefore allied to Aconite rather than 
to Pulsatilla. 

I can thus commend Propylamine to you as having 
all the features of a homoeopathic remedy, acting 
directly and in small doses. I cannot say the same 
of the drug which I have mentioned as having super- 
seded it in ordinary practice. I mean salicin, with 
its derivatives salicylic acid and the salicylate of 
soda. I call these last derivatives of the first, as — 
though ordinarily obtained from other sources — 
salicylic acid appears to be a product of the breaking 
up of salicin in the system, and the action of the two, 
physiological and therapeutical, seems to be identi- 
cal. Now I do not deny that these substances may 
occasionally be homoeopathic to acute rheumatism. 

» Medical Call, July, 1882. 



SALICYLIC TREATMENT. I 59 

Both have been known to induce fever, which, 
though of short duration, has been pretty sharp ; 
and the sahcylate of soda has every now and then, 
in the hands of practitioners of our school, done ex- 
ceedingly well in doses which the ordinary practice 
would deem inert. But I cannot claim for homoe- 
opathy the salicylic treatment of rheumatic fever as 
a whole. , To be of any use — all who employ it affirm 
— the dosage must be large, — ten to thirty grains 
every two hours or so. When thus administered in 
any febrile disease, a considerable reduction of tem- 
perature is obtained, and in acute rheumatism the 
pain and inflammation of the joints is also greatly 
abated. But that the essential malady is not touched 
appears from the fact that cardiac and other com- 
plications are at least as liable to occur, and that 
relapses are decidedly more frequent than when 
improvement has resulted from other measures. As 
compared with alkaline treatment, for instance, heart- 
mischief is nearly twice as frequent, and relapses 
occur three times as often.' Still, it might be said, 
giving all due weight to these disadvantages, the 
benefit obtained is so great, and so unattainable by 
other means, that the salicylic treatment should not 
be withheld from our patients. But there is yet 
another demerit in it. The large dosage required is 
an evil which has not been sufficiently considered, 
either here or in the analogous instances of the 
bromide treatment of epilepsy and the iodide of 
syphilis. You cannot introduce these masses of for- 

^ Lancei, Sept. 20, 1879. 



l6o RHEUMATISM AND THE ANTI RHEUMATICS. 

eign matter into the system without serious injury. 
Already men are beginning to trace kidney disease 
to the too free use of iodide of potassium, as the 
surgeons are finding out that carboHc acid poisons 
patients as well as germs, and the aurists are 
protesting against the injury done to the ears by 
the wholesale quinine-giving now prevalent. That 
salicylic acid and its salts are liable to similar re- 
proaches is pretty well known. As early as .1877 it 
had to be said that '* in a considerable proportion of 
cases they give rise to disagreeable symptoms, such 
as vertigo, headache, tinnitus aurium, and deafness, 
nausea and vomiting after every dose, profuse sweat- 
ing, great weakness, and occasionally a peculiar 
eruption on the skin. More rarely, the symptoms 
assume a dangerous complexion, violent delirium, 
albuminuria, great prostration, with pallid skin and 
feeble pulse, ushering in fatal collapse." ' Since then, 
necrosis (in a strumous child) of the bones of the 
legs and forearm, "^ hyper-pyrexia, and haematuria, are 
among the disastrous effects observed from this acid. 
Salicin is said to be exempt from these reproaches, 
but if, as Senator maintains, it is transformed into 
salicyhc acid in the system, the mischievous agent is 
still produced, and — though less manifestly — does 
its injurious work. 

I think, therefore, that on the whole we shall be 
doing most justice to our acute rheumatic patients 
if w^e resist the temptation to hush up their pain and 

^ Appendix to vol. xvi. of Zieinsseii's Cyclopadia. 
2 Lancet, Oct. 27, 1877; 



HOMCEOPATHIC TREATMENT. l6l 

knock down their fever with salicin and its deriva- 
tives. A man must make his choice : he cannot 
have every advantage and escape every draw-back. 
Under homoeopathic treatment his disease will sub- 
side somewhat less rapidly, but no less surely ; and 
he will run no risk of being poisoned during its 
course, or unduly weakened when he arrives at con- 
valescence. If our patients, knowing what as a gen- 
eral thing homoeopathy can do in comparison with 
ordinary treatment, on this ground seek our aid, we 
may very well be content to treat them homoeopathi- 
cally. I am sure that in the long run they will bene- 
fit thereby ; and that we shall do better by studying 
to give precision and effect to our own anti-rheu- 
matics, than by hankering after the flesh-pots of 
Egypt in the shape of the medication now under 
review. 



VIII. 

RHEUMATISM AND THE ANTI-RHEUMATICS 

{coiiiimied). 

II. At our last meeting, after a review of the phe- 
nomena and pathology of rheumatism, in its various 
forms, we discussed a group of medicines related to 
it as remedies, of which Bryonia was the leading 
member, and Aconite, Colchicum, Pulsatilla and 
Propylamine the subsidiaries. We shall begin to- 
day with a second group, the type of which is to be 
found in a plant very familiar to you in this country 
— the Rhus toxicodendron. 

Some ten years ago, there appeared in England 
a treatise entitled " Materia Medica and Therapeu- 
tics. Vegetable Kingdom. By Charles D. F. Phil- 
lips, M.D., F.R.C.S.E." The author was described 
as " Lecturer on Materia Medica at the Medical 
School of the Westminster Hospital." On turning 
over the pages of this volume (which has since been 
reprinted over here) any one could see that it con- 
tained a large amount of matter hitherto unfamiliar 
in the old school ; and any one acquainted with ho- 
moeopathic literature could recognise the source 
162 



RHUS. 163 

from which the new matter had been derived. The 
fact was that the writer had been an avowed practi- 
tioner of homoeopathy in Manchester for twenty 
years ; but on coming to London found it suit his 
views ostensibly to renounce his hitherto connexions. 
It was nevertheless the special knowledge he had 
acquired as a disciple of Hahnemann which enabled 
him to get into metropolitan practice, to obtain his 
appointment, and to write and publish his book. 

I have made these remarks, because I am going to 
quote Dr. Phillips' description of those pathogenetic 
effects of Rhus which concern us in our present 
study. "Rhus induces pains," he writes, "appar- 
ently of a rheumatic kind, and which are felt not 
only in the limbs but in the body, though most es- 
pecially about the joints. Pain and stiffness in the 
lumbar region are often induced, and to these affec- 
tions is often added a sense of numbness in the lower 
extremities. The structures most powerfully affected 
appear to be the fibrous ones. The pains in ques- 
tion are accompanied by a very slight amount of 
swelling ; and, singular to say, they become intensi- 
fied by rest and warmth." 

Now where did Dr. Phillips get these symptoms } 
His whole description of the effects of Rhus purports 
to be taken from cases of poisoning by contact with 
or emanations from it, — several instances of which, 
he says, he has himself witnessed. But it is a curi- 
ous fact that in none of the poisonings collated by 
Allen (and he has spared no pains to include all on 
record), whether from Rhus toxicodendron or from 



164 RHEUMATISM AND THE ANTI-RHEUMATICS. 

the venenata species, is there any mention of rheu- 
matoid pains being felt. The whole stress of the 
plant's influence here seems expended on the skin 
and the cellular tissue. In the provings of Hahne- 
mann and his associates, however, where the drug 
was chiefly taken internally and in moderate doses 
of the tincture, tearing pains, and especially sense of 
stiffness and aching, in neck, back and extremities, 
were frequently observed, with the absence of swell- 
ing and the conditions of aggravation noted by Dr. 
Phillips. The source of his information is obvious : 
and what shall be said of his candour ? what shall be 
thought of the reviewers who welcome such a vol- 
ume and cast scorn on the authority it implicitly 
recognises ? 

We, happily, are under no such morally-benumbing 
influences, and can freely and openly use good knowl- 
edge wherever we find it. That Rhus can cause 
rheumatoid pain and stiffness we first learnt from 
Hahnemann's pathogenesis of Rhus toxicodendron ; 
and we have had it confirmed by Dr. Joslin's proving 
of Rhus radicans, and those of Kunze, Burt and 
others made with Rhus venenata. In these last the 
joints, as well as the fibrous tissues, were affected — - 
especially the knees, ankles, feet and hands ; but 
there was here also no synovial effusion, as there 
was with Bryonia and Pulsatilla. In all cases para- 
lytic and numb sensations, with ready trembling, are 
present. 

The repute of Rhus as an anti-rheumatic is of 
purely homoeopathic origin, though its remedial 



RHUS. 165 

power is now beginning to be discovered in the old 
school, and even turned to account in our doses. 
At what point this repute originated among us, I 
cannot say ; for Hahnemann makes no mention of 
rheumatism in his preface or notes to the pathogen- 
esis in the Matci'ia Medica Pura. We have seen, 
however, that his main indication for the drug in the 
fever of 1813, in which he so largely and success- 
fully used it, was the presence of pains which were 
worse at rest. This condition of aggravation of the 
Rhus sufferings he mentions again with much empha- 
sis in the preface referred to ; and the inference 
was natural that in rheumatic pains so characterised 
it would prove as useful as Bryonia had been in its 
way. Obviously, therefore, it would find little place 
in rheumatic fever, where the patient generally 
dreads the slightest movement. Cases will occur, 
however, in which — instead of this feature — rest- 
lessness and constant desire to change the position 
are present. Here Rhus will tell ; and also in Aco- 
nite cases, after this drug has done all it can do, but 
*' wearing stiffness and aching in the neighbourhood 
of the joints " (Phillips) annoy the patient. In 
chronic articular rheumatism it is the remedy for 
Watson's second form, where there is " coldness and 
stiffness of the joints," and friction and gentle 
motion relieve. In association with dry heat topi- 
cally — as from hot bran, salt, or sand — it will 
loosen many a stiffened and useless articulation. It 
is especially valuable when this affection is chronic 
from the outset, when the joints and fibres of persons 



l66 RHEUMATISM AND THE ANTI-RHEUMATICS. 

advanced in life begin to stiffen and ache, threaten- 
ing complete and painful disablement. My own 
father, when j^ years old, began to be so afflicted ; 
but under the steady use of Rhus, in rare doses of 
the higher dilutions, he lost all his troubles of this 
kind, and lived to 85 without any return of them. 
But its main sphere is found in the local fibrous 
rheumatisms of which I have spoken — this name 
being due to them from their almost constant origi- 
nation in getting wet. It is this, as well as their 
seat, which calls for Rhus as a remedy ; for another 
point of distinction between it and Bryonia is that 
the former (with — as we shall see — Dulcamara) 
suits the effects of damp,' the latter (with Aconite) 
those of dry cold. It was for this reason that, in 
speaking of Bryonia as remedial in the effects of 
east winds, I explained that I meant those of my 
own country. Those which reach you here in Bos- 
ton must bring plenty of Atlantic moisture with 
them, and their effects will probably call for Rhus. 

Well, then : for rheumatic pain and stiffness trace- 
able to damp and increased by it, in tendons, fasciae, 
ligaments, Rhus is specific. You cannot better 
impress this action of it upon your minds than by 
reading a series of cases by one of the early homoe- 
opathists, Dr. Bolle, of Dresden, which you will find 

^ Dr. Hoyne {Clinical Therapeittics, I., 128) quotes a case of pleurodynia 
supposed to depend on cardiac disease. It refused to respond to remedies 
until traced to a wetting, when Rhus rapidly disposed of it. This may be 
compared with a similar case related by Teste {Mat. Med., sub voce Aco- 
nitum), where exposure to dry cold winds on the Russian plains was found to 
have been the exciting cause, and Aconite proved quite as effective. 



RHUS. 167 

translated from their German original in the twenty- 
fifth volume of the British Journal of Homoeopathy. 
His conclusions are that Rhus answers to affections, 
occurring chiefly in men of strong fibre, occasioned 
by taking cold from wetting when the body was in 
a state of perspiration and excitement, but also when 
no such mental or physical strain had preceded ; 
characterised by tension, lameness and stiffness, by 
tearing, drawing, bruise- and sprain- like pain in 
shoulders, wrist-joint, back, and vastus, and in the 
hips, and not unfrequently from those down the 
thighs to the feet, with occasional sensation of numb- 
ness. The pains had the usual aggravations and 
ameliorations, among the latter being dry heat. 

With regard to the localities specified by Dr. 
Bolle, I would mention that you will often read or 
hear of lumbago and sciatica being relieved by Rhus, 
although it has no action on muscle or nerve. I 
believe it is the lumbar fascia in the first instance, 
the fibrous sheath of the sciatic in the other, which 
is the seat of the malady ; and here of course Rhus 
is quite at home. It is thus well indicated when 
lumbago and sciatica occur together — the whole 
fibrous tract being affected. I would also remind 
you, before leaving this drug, that the indication 
"relieved by motion " is not so absolute as that of 
"worse at rest." I mean that the patient's first 
mpvement, after repose, may be painful enough : but 
he improves as he goes on, while the Bryonia sub- 
ject gets worse the longer the motion continues. 

The analogues of Rhus in relation to rheumatism 
are Dulcamara and Rhododendron. 



l68 RHEUMATISM AND THE ANTI-RHEUMATICS. 

I. Dulcamara has, since Carrere recommended it, 
found no little employment as an anti-rheumatic; 
though it has now pretty well died out of use, and 
Dr. Harley's experiments with it — which seemed to 
shew it totally inert — will not favour its revival. 
Its use among ourselves is not, I think, lineally 
traceable to that which it enjoyed in the old school. 
It has rather grown out of a phenomenon noticed by 
Carrere in some of the patients taking it, viz. : that 
they were liable to twitching of the eyelids and lips, 
and slight convulsive movements of the hands, but 
only when exposed to cold, damp zueather, while exter- 
nal warmth readily removed the symptoms. It was 
a necessary inference that Dulcamara would be ho- 
moeopathically indicated for other affections owning 
such causation ; and if so then certainly for some 
forms of rheumatism. The inference was further 
supported by a considerable array of rheumatoid 
pains in Hahnemann's pathogenesis of the drug, and 
it has been warranted by experience. The following 
case, from the Etudes Therapeutiques of the late Dr. 
Petroz, will illustrate its sphere of action : 

" A 3'oung woman, of a delicate complexion, her skin white, 
fine, almost transparent, inhabited a room situated low down, 
where the temperature in summer differed from that of out- 
doors at least ten degrees " (centigrade). 

" In 1833, during the hot season, every time that after mod- 
erate exercise she returned to her apartment, she felt an im- 
pression which, at first agreeable, finished by being unpleasant. 
One day she complained of heaviness in the head, with a feel- 
ing of stupidity ; she had, at the end of the day, shaking in her 
limbs, some shooting pains in different parts, an extreme fatigue ; 



DULCAMARA. 169 

during the night wakefulness, or an agitated sleep, awaking with 
fright, dry heat of skin, ebullitions of blood. 

" The next day, besides the preceding symptoms, pulse hard, 
contracted, no; slight swelling of the articulations of the wrist 
— carpus and metacarpus ; sharp pain caused by the least move- 
ment; sensation of cold while resting: the articulations of the 
feet were in the same state. 

" In the morning, at 9, Dulcamara 24, three globules. At 
noon some painful drawings were felt in the legs. At two a 
general perspiration took place, without increase of heat, and 
lasted all the night, which was more calm. 

"The third day the skin was in its normal state; the pulse 
was 88 ; touching and movement caused much less pain in the 
affected joints. The improvement made progress. 

" On the fourth day the patient was near convalescence, 
when in the evening she felt violent shooting pains in the right 
forearm and wrist, in the right thigh and knee ; there was wake- 
fulness and agitation. 

"The morning of the fifth day: — frequency, hardness of 
pulse ; sharp pains in the articulations of the superior and in- 
ferior extremities on the right side. The analogy of these symp- 
toms with the effects of Dulcamara was too evident not to lead 
one to recur to that medicine : it was given in the same dose. 
At the end of two hours the skin became moist : the fever was 
soon calmed : the pains decreased progressively, in such a man- 
ner as to render movement possible. 

"On the seventh day all pains had ceased, and since that 
time the health has not been altered." 



This is a fair case of incipient rheumatic fever 
nipped in the bud by Dulcamara (which, I should 
say, is not without febrigenic power) ; and it is pos- 
sible that, had the dose been occasionally repeated 
after the first, the recurrence of the fifth day might 
not have taken place. You will see that quite a high 



I/O RHEUMATISM AND THE ANTI-RHEUMATICS. 

dilution was sufficient : it is so, in my experience, 
with this medicine, and also with Rhus, when either 
is indicated. You will see also that the Dulcamara 
pains have not the relation to rest and motion of 
those of Rhus ; and that the local affection is more 
synovial. They correspond in their sub-acute char- 
acter, and in their exciting cause. 

2. Rhododendfon, the Siberian rose, has a high 
native reputation for gout and rheumatism. Its 
proving by some of the earlier disciples of Hahne- 
mann excited sufficient pains in the muscular and 
fibrous tissues to shew that it was homoeopathic to 
rheumatic affections of these parts, and it has been 
used accordingly with much success in homoeopathic 
practice, — here also the attenuations given having 
been mostly those from the 12th to the 30th. Rheu- 
matism of the cervical and thoracic muscles, and 
rheumatic neuralgia of the extremities — arms and 
legs, figure most largely among the cases affixed to 
the pathogenesis, as originally published in Stapf s 
Beitrage. More lately it has acquired much repute 
for "rheumatic face-ache," i.e. pain about the cheek 
and jaws induced by a draught. The Rhododendron 
pains are like those of Rhus, in that they are worse 
at rest ; but they are relieved at once by movement. 
As the habitat of the plant suggests, they have no 
special relation to damp ; and they do not indeed re- 
quire cold for their exciting cause, though they might 
have it abundantly there. It is the electric condi- 
tion of the atmosphere to which they are especially 
and when you get the feature "worse 



KALMIA. 171 

before a storm," you may always think of Rhodo- 
dendron. 

I am inclined to believe that Rhododendron actu- 
ally affects the nerve-substance itself. At any rate, 
its relation to rheumatism in the face and extremities 
leads me to hang on to it, as a sub-class, two drugs 
mainly efficient in the same direction, Kalmia and 
Spigelia. 

a. In his interesting preface to the proving of 
Kalmia in the first volume of the Transactions of 
the American Institute, the late Constantine Hering 
connects the plant with Rhododendron and with 
another anti-rheumatic which will shortly come before 
us, the Ledum palustre. " Rhododendron " he writes 
** thrives in the region of storms and mountains, 
and Ledum draws its nourishment from the ponds 
of elevated regions, while Kalmia flourishes in the 
mists arising from the valleys. All these inhabit 
northern climates. They correspond to the great 
family of diseases which we comprise under the col- 
lective names of rheumatism and gout ; particularly 
to that class which belongs to the north, and which 
is decidedly distinct from that of the south, and of 
the tropics." It caused rheumatoid pains in abun- 
dance in those who experimented with it. Dr. Bayes 
used to esteem it highly in the rheumatic face-ache 
of which I have just spoken, and Mr. Clifton con- 
firms his estimate from his own experience, adding 
that the pain is generally on the right side, and 
often goes down the arm, while brachialgia itself of 
similar origin will often yield to it. Kalmia affects 



172 RHEUMATISM AND THE ANTI-RHEUMATICS. 

the heart much as Digitalis does, especially slowing 
its beat ; and the affinity may be utilised when rheu- 
matism attacks this organ. We should expect most 
from it when the heart simply becomes the seat of 
rheumatic pain, without inflammation of the organ 
being set up ; but Dr. Dunham relates a case of 
endocarditis so completely cured by it that no valvu- 
lar murmur remained. 

b. Spigelia has a still more decisive action on the 
nerves and heart, and also on the eye. In the last- 
named organ the painful character of the inflamma- 
tion induced in Hahnemann's provers suggests the 
sclerotica and iris as the parts affected, though the 
symptoms are not described with sufficient clearness 
to make a diagnosis possible. We may certainly 
say, however, that it is " rheumatic ophthalmia " 
which the drug causes, and may extend a similar 
conception to its influence on the heart, which is 
denoted by great pressure on the chest, shooting 
pains through it and down the left arm, and violent 
palpitations. Its neuralgia must not be limited to 
the rheumatic kind, as it is genuine and wide-reach- 
ing ; but in practice an origin of this nature has 
always been found a strong indication for it. Its face- 
pains are sharper and more shooting than those of 
Rhododendron and Kalmia, and — unlike the latter 
— affect rather the left side. 

In the eyes and heart, moreover, we must not limit 
Spigelia to rheumatic affections. Ciliary neuralgia 
of every kind, and angina pectoris when a pure neu- 
rosis, come within its range. But the injiaviinations 



CIMICIFUGA. 173 

it controls in these organs are undoubtedly those of 
rheumatic origin. The painful, straight-lined and 
crimson- hued injection of the eye-balls which we 
used to call ''sclerotitis" yields rapidly to it, after 
Aconite ; and it stands facile princeps among our 
remedies for pericarditis and endocarditis rheumat- 
ica. That Fleischmann should have relied upon it 
year after year at the Gumpendorf Hospital m 
Vienna for the cardiac complications of acute rheu- 
matism, and should have been able to report 57 suc- 
cessive cases with only one death, is proof sufficient 
of its efficacy, 

III, I have now to speak of a group of medicines 
whose seat and kind of action are "rheumatic," but 
which are purely local in their influence. Rhodo- 
dendron is the link which connects them with the 
more generally-acting drugs we have left behind us ; 
but their own type is Actaea, or — as you seem here 
to have determined to call it — Cimicifuga race- 
mosa. 

That Cimicifuga causes pains in various parts of 
the body, and these often of some severity, no one 
can doubt who reads its pathogenesis. That these 
are — to some extent, at least — of rheumatic nature 
appears from the interpretation which practice has 
given them. The drug is praised by all in acute 
muscular rheumatisms, as pleurodynia, lumbago and 
torticollis — the first-named having been experienced 
more than once by one of the provers. The differ- 
ential features of its action here — as compared 
with that of Aconite and Bryonia — are hardly yet 



1/4 RHEUMATISM AND THE ANTI-RHEUMATICS. 

established. For its influence on local articulaf 
rheumatisms, however, we have such indications from 
an unusual source, viz. : from Dn Rino-er. It is 
useful, he says, in rheumatoid arthritis, and in joint- 
inflammations -resembling gonorrhoeal rheumatism, 
but without any history of gonorrhoea, when the 
pains are worse at night and in wet or windy 
weather. The "uterine origin " which he requires 
for the former, if the drug is to act well, reminds us 
of Pulsatilla ; and leads me to say that when pain 
and irritability of the womb, whether at the monthly 
period or otherwise, appear to be traceable to rheu- 
matic influences, Cimicifuga is a great remedy for 
them. I know that present-day pathology would 
smile at such a conception ; but it was entertained 
on sound data by men like Gooch and Dewees in 
the past, and I think we should lose therapeutically 
by abandoning it. That another hollow muscle, the 
heart, can be rheumatic is less disputed ; and when 
it is so, its painfulness being less acute than with 
Spigelia, Cimicifuga gives it great help. 

There are four remedies which hang on to Cimi- 
cifuga in its relation to local articular rheumatisms. 

1. Its closest ally is CaiilopJiylhiui^ whose uterine 
action is pretty well identical with it. Now this 
plant, when proved by Dr. Burt, developed in him 
pretty sharp pains in the small joints, and those of 
the fingers were stiff and red. It has thereupon 
been used with good effect in inflammatory rheuma- 
tism of the hands, and among its employers is Dr. 
Ludlam, who has noted its action as being more 
prompt in women than in men so affected. 



LEDUM, RUTA, VIOLA ODORATA. 1 75 

2. Ledum is one of the old Hahnemannian medi- 
cines. Its proving developed marked pain in many 
of the joints, and the ankles and feet appear as ac- 
tually swollen under its use. It is perhaps better 
suited to gout than to rheumatism ; but Pflange, one 
of the Rademacherian school in Germany, reports 
two good cases of chronic rheumatism of the hip- 
joint cured by it. Hahnemann's dictum^ that Ledum 
will prove suitable only in chronic maladies charac- 
terised by coldness and deficiency of animal heat, 
points to the non-inflammatory type of rheumatism 
as its sphere, like Rhus, and like my next medicine, 

3. Riita. This, too, causes marked pain in the 
joints, but goes beyond Ledum (which has shewn 
some power of the kind) in involving also the neigh- 
bouring bones, probably acting on the periosteum. It 
is thus, with the drugs of the Mercurius group to 
which I shall immediately come, suited to the form 
of rheumatism known as "periosteal";" but is some- 
times efficacious in the ordinary kind when affecting 
the wrist, for which I think it has a special affinity. 
You will not forget the uterine influence of this 
medicine also. 

4. Last of our present group in the violet — ■ 
Viola odorata. In the slight pathogenesis of this 

plant which we have in the ArcJiiv, furnished by 
Hahnemann, Gross, and Stapf, two of the few symp- 
toms of the extremities are ''pressing pain in the 
right wrist" and "drawing pain in the right elbow." 
Petroz seems from this shght indication to have been 
led to employ it, and Teste says with success, in vari- 



176 RHEUMATISM AND THE ANTI-RHEUMATICS. 

ous rheumatic affections of the upper limbs. Tes- 
sier then took it up, and published in the Gazette 
HomceopatJdqite de Paris several cases of inflamma- 
tory rheumatism which rapidly recovered under this 
medicine in the 12th dilution. In all the right side 
alone waS affected, and the wrist joint was always 
the first to experience amelioration. Dr. Kitchen, 
of Philadelphia, translating these cases for an Ameri- 
can journal, adds three of his own, in which cure at 
least as rapid occurred under the ist dilution. In 
one the affection was limited to the right side, but 
in the other two it was bilateral ; and here the curi- 
ous feature appeared, that the left wrist seemed 
entirely insensible to the action of the remedy, so 
that it remained painful and swollen for some days 
after its fellow had got well, and compelled resort to 
other medicines.' 

IV. My next group of anti-rheumatics is a some- 
what peculiar one. It consists of three members 
only, and its type is Mercurius. 

In the last edition of my P haiinacodynamics I have 
spoken (as previously) of the well-known *' mercurial 
rheumatism," and have suggested that this is mainly 
a periostitis. But I have also called attention to the 
profuse and odorous sweats giving no relief, which 
characterise rheumatic fever, and which — when oc- 
curring otherwise — are always indicative of the 
remedy ; and also to the sallow and red tint of the 
face, with oily perspiration, which Dr. Anstie has 
remarked as frequently premonitory of it, and which 

I See Brit. Journ. of HotJt., XXIV., 314. 



MERCURIUS. 177 

no less plainly suggests mercurial preparations. I 
have accordingly recommended Mercurius to be given 
in sub-acute forms of the disease, readily relapsing, 
where the pains (unlike those of Pulsatilla) do not 
shift about much, and are markedly worse at night 
— the patient being very sensitive to cold. 

I do not think, however, that we must lay too 
much stress on these symptomatic resemblances, so 
as to depend on Mercurius in rheumatic polyarthritis. 
Its fever (which no one has described more graphi- 
cally than Hahnemann') is very unlike the rheumatic, 
as contrasted with which also it has diminution in- 
stead of excess of fibrin in the blood. On the other 
hand, it shews undoubted power of locally inflaming 
the joints. From Ruber's very exhaustive treatise 
on " Mercury and its preparations," now in the course 
of appearing as a supplement to the Noj'th American 
yonrnal of Honiceopat/iy, I extract the following. 
'' Dietrich thus describes the mercurial arthritis : A 
slight stitching, pressing pain in the joints sets in; 
the joint swells up and becomes of a pink or dark 
red color. This redness disappears on pressure, 
but returns immediately. The swelling is neither 
hard nor doughy, and feels hot to the touch. When 
at rest and at a low temperature the pain is moder- 
ate ; but becomes more severe during motion and in 
the heat of the bed (especially from Merc. corn). 
It may end in caries or anchylosis. Wilhelm, 
Handschuh, Warbeck de Chateau and Stokes also 
speak of a mercurial rheumatism, attacking the knee 

^ See Pharinacodyiiainics, p. 626. 



178 RHEUMATISM AND THE ANTI-RHEUMATICS. 

and shoulder joint, more rarely the hip-joint, elbow 
and carpus ; sometimes in the form of an acute rheu- 
matism, leading to hydrarthrosis or to suppuration 
of the joint. Richter ascribes especially to the cor- 
rosivus the power of causing rheumatitis ; and Kuss- 
maul acknowledges that painfulness of the joints 
is frequently observed in workers in mercury, but 
denies that inflammation or exudation in the joints 
follows such occupation. Lendrick, on the contrary, 
observed, in consequence of the abuse of mercury, 
swelling of the joint with considerable exudation in 
its cavity." 

Such facts go to warrant the recommendation of 
Mercury I have made in my Thej^apetitics, viz. : that 
it should be given when the inflammation is obsti- 
nate in any one joint. They would also suggest it 
in a form of acute articular rheumatism which has 
not yet come before us — the gonorrhoeal. And this 
leads on to another *' rheumatic " application of our 
drug. You may be aware that there are some per- 
sons who never contract gonorrhoea without getting, 
not rheumatism only, but also iritis. (This is quite 
different from the ordinary "gonorrhoeal ophthalmia," 
which is due to some of the virulent matter coming 
in contact with the conjunctiva, to which membrane 
it is limited, and which attacks one eye only.) Now 
the association of Mercury with iritis is quite tradi- 
tional, and has descended without break of continuity 
into homoeopathic practice. In a paper which you 
will find in the tenth volume of the Annals of the 
British Homoeopathic Society I have examined into 



MERCURIUS. 179 

the matter. I have shewn that the common idea 
that iritis is readily caused by Mercury is quite 
unfounded, — the two authorities usually cited in 
favour of it, Graves and Travers, both recognising 
in their cases the presence of two other factors of 
much greater importance, syphilis, and cold and 
damp ; while it has never been observed among the 
workers in the metal. A single exception made by 
Travers to his statement that all his patients were 
syphilitics, and an observation of Basedow's in which 
an ''iritis mercurialis " appeared in a patient being 
treated with the drug for hepatitis, were the sole 
evidence I could find of the possibility of the dis- 
ease being induced by it. Considering, then, the 
plastic nature of syphilitic iritis, and the necessity 
recognised by the most careful oculists for inducing 
to some extent the physiological effects of the drug 
if it is to overcome it, I was forced to the conclusion 
that it was not homoeopathic thereto. Its reputation 
in our school was due, I thought, to its power over 
rheumatic iritis, especially when of serous character, 
and this variety of the affection it might have caused. 
I wrote all this before Ruber's essay had reached 
the section on iritis. I find here the usual assump- 
tions made, which analysis readily resolves ; but a 
few fresh facts are contributed. " Many authors " 
we are told " such as Hunter, Bele, Scarpa, Pearson, 
Ammon, Werklin, Travers, M. Jaeger and many 
others, do not admit the existence of syphilitic iritis, 
but ascribe the same to the effects of mercury." 
They may have been of this opinion, but if it rested 



l8o RHEUMATISM AND THE ANTI-RHEUMATICS. 

on no better foundation than in Travers' case, their 
authority is of little value. If, moreover, supposed 
syphilitic iritis were really of mercurial origin, why 
did they all treat it with Mercury ? The therapeutic 
evidence adduced by Huber goes against his thesis, 
as his two clinicians of most weight — Kafka and 
Payr' — find it necessary, in the syphilitic form of 
the malady, to resort to mercurial inunction, as did 
Dr. Dudgeon in a case referred to in my paper. But 
three fresh observations, besides Basedow's, are given, 
which strengthen the evidence for the homoeopathicity 
of the drug to some form at least of the disease. 
One is rather slight: — *' Cooper, while administer- 
ing mercury in a scrofulous affection, observed the 
development of iritis." I do not know what Cooper 
this may be, nor where his observation is recorded ; 
so must let it pass qiianhim valeat. The second is 
taken from von Ammon's ZeitscJirift fiir OphtJial- 
mologie : "In a man and a woman who had taken sub- 
limate for chancre, but were not salivated, there 
appeared inflammation of the right eye, which in- 
volved not only the posterior surface of the cornea, 
but also the serous covering of the iris. The pupil 
was angular ; the eye very painful, as if too small ; 
all the sensations aggravated in bed." Here the 
patients had chancre, which might have been syphi- 
litic ; but on the other hand the iritis was serous 
only, which makes against such an origin. Thirdly, 
the ''case of Werklin " is mentioned, but no refer- 
ence given to it. Dr. Huber states that in this *' iritis 
appeared together with gummy tumours in a patient 



MERCURIUS. I8l 

who never had syphilis, and who took calomel with 
opium for facial rheumatism. In the Hst of enumer- 
ated symptoms" he goes on ''we find injected state 
of the vessels ; pressing, burning pain in the eye ; 
photophobia ; induration of the iris ; irregular shape 
of the pupil, and hypopion ; there was violent burn- 
ing pain in the supra-orbital region of the forehead ; 
the sight was nearly gone." As against the sugges- 
tion that the iritis, like the face-ache, might have 
been rheumatic, he advances the more intense char- 
acter and more rapid course of that form of the dis- 
ease. 

While, then, we want more evidence, and I must 
still sum up as against the homoeopathicity of Mer- 
cury to syphilitic iritis, I think that the case is 
strengthened in favour of its having power to cause 
this inflammation in some shape ; and I should think 
the rheumatic variety of iritis — i.e. that which oc- 
curs from cold and damp, or in connexion with gonor- 
rhoeal rheumatism — the best suited to it, and the 
corrosive sublimate the best form in which it can be 
given. 

I have dwelt somewhat long on this point, but it 
is one of importance, and it illustrates the mode of 
analytical and critical study of drug-action which you 
may often find it advantageous to follow. Merely 
saying, in passing, that in what may be called " peri- 
osteal rheumatism" — such face-ache, e.g., as results 
from draughts of cold and damp air, Mercury — 
again best as corrosive sublimate — is very effective, 
I pass on to its analogues, which are Kali bichromi- 
cum an4 Phytolacca. 



1 82 RHEUMATISM AND THE ANTI-RHEUMATICS. 

I. Of Dr. Dr3^sdale's provings and presentation of 
Kali bicJiromiaim I do not like to say too much, as 
Dr. Samuel Jones — who is a humourist — says that 
it is the only ^^g of the kind we British have ever 
laid, and that we never cease to cackle over it. Well : 
it is not quite the only one, and it is a good one ; 
but I mention it now (not to cackle, but) just to say 
that a revised edition of it is on the point of appear- 
ing (with the Aconite and Crotalus of which I have 
already spoken), and that, among other things, it will 
shew a striking confirmation — from an old-school 
source — of the recommendation of the drug in 
syphilis which Dr. Drysdale made on the strength of 
its pathogenesis in 1852. It is just in the tissues 
liable to be affected by both rheumatism and syphilis 
— the periosteum and the iris — that the chief part 
of Kali bichromicum as an anti-rheumatic is played. 
On the periosteum it really exerts a very marked 
influence, — manifested not only by pain at certain 
spots in the membrane, but by the characteristic 
hard swellings of sub-periosteal effusion. These 
were seen in the provers on the parietal and maxil- 
lary bones, and on the tibia (§§ 136, 499, 1450 of 
Allen). Marked tearing pains were also experienced, 
especially about the joints, pointing to a similar affec- 
tion of the other fibrous tissues ; and one of the 
Austrian provers, who took the second trituration, 
had " several bright red spots and streaks on the 
white of the left eye," which looks like sclerotic 
injection. 

Kah bichromicum vies (to say the least) with Mer- 



PHYTOLACCA, ARSENIC. 183 

curius in rheumatic ophthalmia : it is especially suita- 
ble to the form known as "catarrho - rheumatic," 
where the conjunctiva corneae is involved. Its action 
on fibrous tissue has led to its successful use in a 
number of local rheumatisms, of the chronic and 
*'cold" variety. In Dr. Drysdale's arrangement of 
it you will find cases of lumbago and sciatica, of 
rheumatic headache, and of periostitis, which have 
been very satisfactorily cured by it. In the first- 
named, as with Rhus, I should think the lumbar 
fascia and the sheath of the nerve the seat of the 
mischief. 

2. It was in affections of these parts that the 
power of PJiytolacca as an antirheumatic first ap- 
peared ; and a recent case of overdosing by it has 
shewn a power on its part of causing periostitis of 
the face and forehead. The accompanying symp- 
toms in this case suggested syphilis rather than 
rheumatism ; so here again we have a drug belong- 
ing to the borderland between these two diseases. 
Its differential indications have not yet been estab- 
lished. 

V. The power of Arsenic to inflame the serous 
membranes might have been anticipated to extend to 
their synovial analogues ; and the conclusion has 
been substantiated by facts. Dr. Imbert Gourbeyre, 
who has made Arsenic an almost life -long study, and 
to whom we owe so much knowledge regarding it, 
has studied this branch of its action in his " Suites 
de I'Empoisonnement Arsenical" lately (1880) pub- 
lished in L Art Medical. The articular affections of 



184 RHEUMATISM AND THE ANTI-RHEUMATICS. 

the drug are seen chiefly during convalescence from 
acute poisoning by it. They chiefly consist of pains ; 
but in several cases swelling has been observed, and 
in one at least there was " an intense arthritis of all 
the large joints." Dr. Gourbeyre has himself seen 
a general articular rheumatism supervene on the 
administration of Fowler's solution for eczema ; and 
that it was due to the medicine appeared from its 
recurrence, a year after, on similar treatment being 
attempted. 

Such facts are not unfamiliar to the ordinary 
works on toxicology, but they have not prevented 
old-school physicians from treating chronic articular 
affections with Arsenic. Phillips cites Haygarth, 
Bardsley, Christison, Begbie and Fuller (to whom I 
may add Elliotson) as warranting its efficacy ; and 
adds — "I quite agree that the remedy promises well 
in cases where the vital powers are diminished, and 
the ends of the bones, the periosteum, capsules, and 
ligaments are swollen ; under the continued use of 
the drug I have known the joints return to their 
natural size." The source of this experience would 
lead us, in endeavouring to reproduce it, to use the 
drug in the form of the liquor arsenicalis. 

I. I have placed Acidiim lactiatin under Arsenic, 
because I cannot think that its remarkable power 
of inflaming the joints — as observed by Foster — 
should remain without utilisation. It cannot be 
employed in rheumatic fever, because there in all 
probability it is the materies morbi ; but in some 
sub-acute local inflammations of joints, from rheu- 



J 



SULPHUR. 185 

matic causes, it should prove very effective. The 
articulations affected in his cases were, I should say, 
those of the knees, elbows, wrists and hands ; and 
they were red, hot, and swollen, as well as painful. 

VI. Of Sulphicr, which as an anti-rheumatic stands 
by itself, I have only to remind you of what I have 
written about it in my Pharmacodynamics. The rep- 
utation it enjoys among the common people for their 
''rheumatics," carried in their pockets, put under 
their pillows, or dusted within their stockings, is 
echoed more scientifically but not more convincingly 
by the experience gained at sulphureous springs, 
such as those of the Pyrenees. Its homoeopathicity 
is suggested by the minute dosage thus involved ; 
and is confirmed by the Austrian provings, where 
rheumatoid pains were very frequent, and one experi- 
menter, being sceptical as to its influence, tested 
it by alternately omitting and resuming the drug, 
when he found his pains invariably shewing a corre- 
sponding decline or increase. At the same time 
you will notice that the dosage, though minute, is 
hardly infinitesimal. Sulphur is not an "anti- 
psoric " here, and acts better (I think) in the second 
trituration originally recommended by Hahnemann 
than in his later 30th. 

Such, ladies and gentlemen, is our treasury of 
anti-rheumatics, and I think we may feel rich alike 
in their number, in the precision of their indications, 
and in their tried worth. By our comparative sur- 
vey of these and of the anti-pyretics we have, I 



l86 RHEUMATISM AND THE ANTI-RHEUMATICS. 

hope, gained some positive knowledge ; while we 
have also learned lessons as to one mode of study- 
ing Materia Medica. Our week has been occupied 
with preparation for two of the oldest and common- 
est tasks of practical medicine, — the subdual of 
fever, the relief of rheumatismo *' To-morrow" — 
or rather on Monday — 

" To fresh woods and pastures new." 



IX. 

CEREBRAL LOCALISATION AND DRUG ACTION. 

The field into which I have now to ask you to 
follow me is somewhat different from that which we 
have hitherto been surveying. In fever and rheuma- 
tism we have taken forms of disease as the sphere of 
action of groups of drugs ; and the light which has 
illuminated the phenomena we have studied has been 
that of pathology. It is now rather an anatomical 
region which will constitute our base of unity ; and, 
though pathology will play her part farther on, the 
lamp we shall take with us all the way will be that 
which is lighted by physiology. We have to view 
the last and crowning discovery of this science in 
regard to the functions of the nervous system, and 
to see how far our pharmacology can fit in with it, 
and make it fruitful for therapeutic ends. 

I say that cerebral localisation is the crown of a 
long series of researches into the functions of the 
nervous system, and localisation has been the key- 
note of all previous attainment in this field. The 
first rough survey divided the whole into brain, spinal 
cord, and nerves, of which the second was consid- 

187 



155 CEREBRAL LOCALISATION. 

ered simply a bundle of nerves proceeding from the 
first, and emerging as the third to be channels along 
which the "animal spirits," generated in the brain, 
passed into the frame. The first step in differen- 
tiation was to recognise the spinal cord as an inde- 
pendent centre : this was done, from physiological 
and pathological considerations, by Whytt, Unzer, 
and Prochaska in the last century, but finally estab- 
lished on anatomical grounds by Gall at the begin- 
ning of the present. Then came the epoch-making 
discovery of Sir Charles Bell (1811), that the anterior 
and posterior roots of the spinal nerves subserved 
different purposes, the former being exclusively 
motor and efferent, the latter sensitive and afferent. 
As the situation of these roots corresponded, roughly, 
to a division of the cord into anterior and posterior 
columns, this was made ; and the former were con- 
sidered as conveying motor impulses from the brain, 
the latter sensory impressions to it. Then, when 
Marshall Hall's researches and writings had revived 
the notion of the reflex function of the cord, first 
broached by the physiologists of the last century 
whose names I have mentioned, its central gray 
matter was supposed to be the seat of such autonomy 
as it enjoyed. The brain — the contents of the 
cranium — next received partition. As the posterior 
columns of the cord, through the restiform bodies 
of the medulla oblongata, terminated in the cere- 
bellum, this seemed to be the sensory centre ; while 
the cerebrum was that in which ideas and emotions 
issued in volitions, which passed through the crura 



SENSATION AND VOLUNTARY MOTION. 189 

cerebri, the anterior pyramids and corresponding 
columns of the cord through the motor nerves to 
the muscles. 

So, speaking generally, things were understood 
during the first decades of the present century. The 
last fifty years, however, have seen a rapid and steady 
progress, which, while substantiating some of these 
notions, has revolutionised others, and has pre- 
pared the way for the final conception which it is 
my present object to elucidate. 

The first thing done was the disengagement of the 
cerebellum and its spinal connexions from all share 
in sensation and voluntary motion. Flourens found 
by experiment that its gradual destruction by slicing 
had no effect on sensibility or on the power of the 
limbs, but that the faculty of harmonious movement, 
such as that required for standing, walking, leaping, 
and so forth, was lost. He accordingly propounded 
the view that the cerebellum was the organ of co-or- 
dination of muscular motion. Todd, following him, 
maintained that the posterior columns and restiform 
bodies were not channels of sensory impressions, but 
the medium whereby the cerebellar influence was 
conveyed to the parts specially needing it — the 
lower extremities. In support of this view he 
pointed out that the columns in question were uni- 
form in size throughout the cord until its termination 
in the lumbar enlargement and cauda equina ; and 
that disease in any part of their course caused just 
such derangement of harmonised motion as the 
hypothesis required. 



IQO CEREBRAL LOCALISATION. 

Now the facts adduced by Flourens and Todd have 
never been disputed ; but their theory, though reign- 
ing for a time, has always been beset with difficulties. 
The phenomena of disease of the cerebellum have 
not lent themselves to it : section of the posterior 
columns, through which alone the cerebellum can 
communicate with the lower limbs, has been found 
to produce no impairment in their motorial power, 
simple or harmonised ; and, lastly, observations which 
I shall hereafter bring before you have shewn that 
the path of nervous influence along these columns 
and their restiform continuations is not from above 
downwards, as the theory would require, but the re- 
verse — not " peripherad," as the electricians say, 
but "centrad." Another hypothesis was required 
which should embrace these facts as well as those 
previously ascertained ; and it has been supplied by 
Dr. Ferrier. He maintains the cerebellum to be the 
centre of equilibration, the seat of association of 
those combined impressions and movements which 
result in the preservation of balance under all cir- 
cumstances. The impressions which convey the 
sense of need of adjustment come through three 
channels — the eye and optic tracts, the semicircu- 
lar canals of the internal ear with their afferent 
nerves, and the paths of tactile sensibility. In these 
last the posterior colunrns find their place, and the 
old conception of their function is somewhat reha- 
bilitated. For, though it is not along them that 
peripheral impressions travel to become conscious 
sensations, they do transmit from below upwards those 



EQUILIBRATION. IQI 

tactile changes in the soles of the feet during stand- 
ing or walking which have so much to do with our 
due balance. This is well seen in the disease called 
locomotor ataxy, in which they are extensively af- 
fected with sclerosis ; where walking is effected by 
a series of jerks, and where, if the optical aid to 
equilibrium is removed by closing the eyes, the pa- 
tient immediately feels as if he would fall and has to 
grasp at some support. The effect of these visual 
impressions ordinarily only comes thus in aid of the 
others ; but it is strikingly seen when perverted by pa- 
ralysis of some of the ocular muscles, whether in dis- 
ease or from the action of certain dru^rs, as Gelsemium 
and Conium. The part played in equilibration by the 
semicircular canals was ascertained experimentally 
by Flourens, and has been confirmed pathologically by 
the phenomena of Meniere's disease. It is through 
the fibres of the auditory nerve, of course, that their 
influence is conveyed ; but in its perversion there is 
no necessary impairment of hearing, as there is none 
of vision in the corresponding ocular derangement. 
Well : the cerebellum being connected with all these 
central paths, and receiving their impressions, trans- 
mits them peripherad through the motor paths, with 
which it is equally connected by means of its middle 
peduncles. Here they are transformed into such 
movements as are requisite to preserve or restore the 
balance. Through its superior peduncles, moreover, 
the cerebellum is connected with the cerebrum, the 
seat of consciousness ; and here loss of balance finds 
its subjective complement in vertigo, the sense of 
giddiness. 



192 CEREBRAL LOCALISATION. 

I have only been able to give you a brief outline 
of these interesting facts, of which however you 
have probably heard something from your teachers. 
But I would strongly advise you to study the fourth 
and sixth chapters of Dr. Ferrier's *' Functions of 
the Brain," in which you will find the whole matter 
fully discussed. His conclusion is that *'the cere- 
bellum would seem to be a complex arrangement of 
individually differentiated centres, which in associ- 
ated action regulate the various muscular adjustments 
necessary to maintain equilibrium of the body ; each 
tendency to the displacement of the equilibrium 
round a horizontal, vertical or intermediate axis, act- 
ing as a stimulus to the special centre which calls 
into play the antagonistic or compensatory action." 
Accepting this, we may put out of view the cere- 
bellum and its spinal connexions in proceeding up- 
wards to our goal — the cerebral convolutions. 

The next great advance in spinal localisation was 
made by one in whom America has at least half a 
share — Dr. Brown-Sequard. By his experiments 
on the cord, and observations of its diseases and 
injuries, he has proved that the conductors of sensi- 
tive impressions to the brain run in the gray matter, 
while — as was always believed — those which con- 
vey motor impulses from it occupy (only to a limited 
extent, however, as we shall see) the antero-lateral 
white columns. He has also ascertained, moreover, 
that while the motor tracts cross over to the oppo- 
site side — as you know — in the medulla oblongata, 
the sensory fibres make their decussation almost im- 



THE CRURA CEREBRI. 193 

mediately upon their entrance into the gray matter. 
Disease or injury, therefore, limited to one lateral 
half of the cord, will cause paralysis of the same 
side of the body, but anesthesia of the opposite. 
Above the medulla oblongata the cross-action is 
complete, so that each crus cerebri which emerges 
from the pons Varolii represents the motor and sen- 
sory functions of the opposite half of the body. 

And here again we have to localise. The crura 
cerebri are separable into two divisions — the upper 
portion, or tegmentum, and the lower, or pes. In 
the upper, it is ascertained, run the sensory fibres ; 
in the lower, the motor. The tegmentum has at its 
termination the ganglionic mass called the optic 
thalamus, the pes has the corresponding corpus 
striatum, which thus, like capitals of columns, crown 
the sensory and motor tracts of the cranio-spinal 
axis. Being closely connected, they form the double 
key-stone of an arch along which impressions may 
be converted into movements without the interven- 
tion of the higher centres. They stand thus in the 
second of the five circuits which such currents can 
traverse. The lowest is constituted by those ac- 
tions specially called ''reflex" which have the spinal 
cord for their centre, and which are seen even when 
this is cut off from all communication from above. 
The next appears in the automatic functions of the 
medulla oblongata — sucking, swallowing, respira- 
tion &c. The third belongs to the mesencephalon 
and cerebellum : it is illustrated by the mechanism 
of equilibration, as it has just come before us. The 



194 CEREBRAL LOCALISATION. 

second, as I have said, we have here ; and the first 
and highest is that channel for actions requiring 
conscious discrimination and voluntary effort which 
we are about to consider. 

For the basal ganglia — the corpora striata and 
thalami optici — are not, as you know, the topmost 
of the nervous centres. From them again radiates 
a blended sheaf of white nerve-fibres, that terminate 
in the cells constituting the gray matter of the cere- 
bral hemispheres, which underlies the whole vault of 
the cranium from forehead to occiput. It has always 
been recognised that this is the seat of conscious- 
ness, the middle point at which mind touches matter; 
where impressions become sensations and the will 
developes itself in action ; and in the force generated 
wherein alone (in the present state of being) the in- 
tellect finds its means of operation. Nothing that 
has since been ascertained alters this view of the 
position of the cerebrum proper. The phenomena 
which some have supposed to indicate a sort of con- 
sciousness on the part of the spinal cord, even those 
which have led Carpenter to designate the automatic 
actions of the basal ganglia as se7zso?^i-motor, have 
been shewn to require no such assumptions. That' 
there may be consciousness — the subjective side of 
impressions and actions — the integrity and co-opera- 
tion of the gray matter of the hemispheres is indis- 
pensable. 

In respect of the mode of its co-operation, how- 
ever, it had hitherto been conceived that the brain 
acted as a whole. The sensory nerves coming from 



DIFFERENTIATION OF FUNCTIONS. I95 

all parts of the frame were integrated in the optic 
thalamus, and there — through its connexions with 
the cerebrum — the mind as one perceived them, 
and translated them into ideas. The influence of 
such ideation, or the direct commands of volition, 
were in like manner conveyed to the corpus stria- 
tum, and thence to the motor nerves of the muscles. 
When enquiry was made as to how sensations were 
discriminated by the mind, or complex actions exe- 
cuted at will, the answer was given by pointing to 
the continuously separate fibres of sensory transmis- 
sion, and to the associated motor cells of the anterior 
cornua of the cord. The former are telegraphic 
wires, each conveying without confusion its own 
message : the latter are so many batteries of Leyden 
jars connected one with another, the electric force 
distributed uniformly over all the united jars, and all 
being at the same time uniformly discharged, for 
which purpose one conductor alone is necessary. 

It is sometimes claimed for the phrenologists that 
they anticipated that differentiation of cerebral func- 
tion which is now acknowledged. But the concep- 
tion of Gall and Spurzheim was of a very different 
order. They divided the mind itself into " faculties," 
to each of which they assigned a certain portion (of 
pretty uniform size) of the surface of the brain, as- 
certaining this by the corresponding elevations or 
depressions of the cranium supposed to exist in per- 
sons variously endowed. Phrenological science, then 
(such as it was), was a compound of psychology (a 
very crude one) and craniology ; while the art (such 



196 



CEREBRAL LOCALISATION. 



as it was) should rather have been called cranioscopy. 
But Gall, who was a man of genius, and who first 
taught us to examine the brain in a rational way, did 
really perceive something which lies at the bottom 
of our present views. The convolutions of the cere- 
brum, which until quite recently were regarded as 
only so many folds designed to give ampler surface in 

B 



— OL 



if 




Left Hemisphere of the Brain of the Monkey (Macacque). 

A. The fissure of Sylvius. B. The fissure of Rolando. C. The parieto-occipital 
fissure. FL. The frontal lobe. PL. The parietal lobe. O L. The occipital 
lobe. TSL. The temporo-sphenoidal lobe. — F\ The superior frontal convolu- 
tion. F2. The middle frontal convolution. F'>, The inferior frontal convohuion. 
sf. The supero-frontal sulcus, if. The infero-frontal sulcus, a p. The antero- 
parietal sulcus. A F. The ascending frontal convohuion. A P. The ascending 
parietal convolution. PPL. The postero-parietal lobule. A G. The angular 
gyrus. //. The intra-parietal sulcus. T\, Ti, T^. The superior, middle, and 
inferior temporo-sphenoidal convolutions, ii, t-z. The superior and inferior tem- 
poro-sphenoidal sulci, ^'i, 01, ^3. The superior, middle, and inferior occipital 
convolutions. o\, 02.. The first and second occipital fissures. 

a limited space, must — he argued — have a more defi- 
nite significance, from the regularity with which they 
occur. So evident was this regularity that physiolo- 
gists—among whom Gratiolet and Leuret are worthy 
of special mention — have named them, and the result 
is what you have all learnt in your anatomy classes. 



CONVOLUTIONS OF THE CEREBRUM. 



197 



The two great fissures — that of Rolando above, 
that of Sylvius below — if caused to meet would 
about divide the lateral surface of each hemisphere 
into two equal parts. In front of this line is a ver- 
tical convolution, called the ascending front aly and 
three horizontal ones — the siLperior^ middle, and in- 
ferior fivntal. Behind it is a corresponding perpen- 



Cms 




^Cj 



The Interxai, Aspect of the Right Hemisphere of the Monkey (Macacqiie.) 

CC. The corpus callosum divided. C. The internal parielo-occipital fissure. Cms. 
The calloso-marginal fissure. Cf. The calcarine fissure, df. The dentate fis- 
sure. Cs. The collateral fissure. G F. The gyrus fornicatus. CM. The 
marginal convolution. G U. The uncinate convolution. 6". The crotchet, or 
.subiculum cornu Ammonis. Q The quadrilateral lobule, or praecuneus. Z. 
The cuneus. FO. The orbital lobule. 



dicular fold — the ascending parietal, ending above 
in the postero-parietal, and flanked by the angular 
gyms ; while below these, reaching to the base of 
the hemisphere, are the three temporo-sphenoidal 
convolutions — superior, middle and inferior. These 
are all of which — on this surface of the brain — I 
need remind you ; though you will not fail to observe 
that beyond their range, both in frontal and occipital 
regions, there is a projecting portion of brain-sub- 



IQS cerebral LOCALISATIO^. 

stance. But I must ask you also to follow me while 
I draw as it were the hemispheres asunder, divide 
the corpus callosum, and expose the inner surface. 
Here, too, are convolutions, but I need trouble you 
with one alone, lying at the base, viz. : the uncinate, 
which immediately overlaps the hippocampus major, 
and its recurved termination, the ''crochet," or sub- 
iculum cornu Ammonis. These are the only parts 
of the brain which have as yet been differentiated, 
and they seem to contain the centres of all the bodily 
movements and sensations. 

The earliest suggestion of cerebral localisation grew 
out of the phenomena of apJiasia. There is a form 
of paralysis — the glosso-laryngeal of Duchenne, the 
old " paralysis of the tongue " — in which the patient 
cannot speak because the muscular apparatus of ar- 
ticulation has lost its power. But there are circum- 
stances of a widely-different nature under which the 
faculty of speech may be lost. The tongue and lips 
may be freely movable. The integrity of the larynx 
appears from the utterance in a natural voice of one 
or more words. But with language in general the 
sufferer has as little power of dealing as a deaf-mute. 
He does not necessarily lack ideas, but he has for- 
gotten those symbols of our ideas which we call 
words. If you shew him a spoon, he recognises it, 
and knows its use. But ask him if he knows its 
name, and he will shake his head. Ask him if it is a 
fork, and he will dissent ; suggest the true name 
*' spoon," and he will signify approval. The memory 
is therefore capable of being aroused. But the faculty 



APHASIA. 199 

of remembering is permanently impaired ; for repeat 
your question as to his knowledge of the name a few 
minutes later, and he will again sign a negative. 

Nor is it the memory of words only that is lost : 
the power of articulating them is also absent. Al- 
though you have reminded the patient of the name of 
the object before him, he cannot pronounce it after 
you. He can perhaps say "yes" or '' no," though 
he often misplaces them : or he utters in reply to 
every question, and spontaneously also, some un- 
meaning word, as (in two patients of Trousseau's) 
"sapon," ''cou-si-si." But no conversation can be 
held with him. 

This is the typical aphasic, though there are great 
varieties in degree in particular instances. Refer- 
ring you for these, and for a full discussion of the 
subject, to those fascinating Clinical Lectures of 
Trousseau which every practitioner ought to read, I 
would say that while aphasia sometimes appears 
alone, it is more commonly associated with more or 
less hemiplegia. Now, when this latter occurs, it is 
almost invariably on the right side of the body, which 
implies — as you know — that the lesion is on the left 
side of the brain. There, then, for some reason or 
other, must be the seat of the faculty of speech. 
Now the craniology of the school of Gall had placed 
the organ of language in the anterior part of the 
brain. In the left frontal lobe, accordingly, the 
lesion of aphasia was sought by Dr. Paul Broca, and 
was found by him in the posterior extremity of the 
inferior frontal convolution on the left side. So 



20O CEREBRAL LOCALISATION. 

many observations have since confirmed him, and the 
few apparent exceptions have been so satisfactorily 
explained, that the localisation has been universally 
accepted, and the fold of brain is known as " Broca's 
convolution." The occasional limitation of the mis- 
chief is explicable by the spot being supplied by 
one of the secondary branches of the middle cere- 
bral artery — plugging of which by embolism or 
thrombosis will cause the symptoms. But why the 
faculty of speech should be located at this spot, and 
why on one side only of a bilateral organ like the 
brain, remained a puzzle as long as the phenomenon 
stood alone. 

In 1870, however, the step was taken which opened 
the whole field of discovery, and has brought us our 
present acquisitions. The most fruitful plan by 
which nervous function has hitherto been ascer- 
tained has been the excitation of the part to be 
questioned by electricity. Up to the time I have 
mentioned, the few attempts made to electrise the 
cerebral surface had failed, and it was supposed to 
be insensible to such stimulus, — as it is known to 
be to any of a painful character. Now, however, two 
German physiologists, Fritsch and Hitzig, ''estab- 
lished, by a series of valuable experiments on dogs, 
that the direct application of the galvanic current 
to the surface of the hemispheres in certain regions 
caused movements ; and also the more important 
fact, that definite muscular contractions were asso- 
ciated with irritation of certain circumscribed areas " 
(Ferrier). They used a continuous current, availing 



THE SEAT OF SENSATION. 201 

themselves of the stimulus which follows the making 
and breaking of the circuit. In 1872, Dr. Ferrier — 
another ornament of my alvia mate?-, King's College, 
London — began a series of experiments of the 
same kind in which he employed the induced current, 
thereby getting more prolonged effects, and (after a 
time) using monkeys as his subjects and so having 
the closest approximation to the human brain. His 
results, which entirely agreed with those of Fritsch 
and Hitzig as far as theirs went, were published from 
time to time in various places, and at last collected 
(in 1876) in the volume I have already mentioned. 
At first there were many to dispute the validity of 
his conclusions, — it being maintained that the phe- 
nomena arose from conduction of the currents to 
the basal ganglia. This, however, was readily dis- 
proved ; and, since then, normal and pathological 
anatomy, clinical medicine and surgery, and even 
embryology, have come to his aid ; and the doctrine 
as a whole must be considered established, whatever 
may be the modification in detail it is destined to 
undergo. 

What, then, is the doctrine .-* It is that this middle 
region of the cerebral hemispheres, lying about the 
fissures of Rolando and Sylvius, embracing the con- 
volutions I have named to you, and corresponding 
roughly to the parietal and squamoso-temporal regions 
of the skull, is the ultimate seat of sensation and the 
starting-point of volitional impulses. The doctrine 
further states, that the several convolutions of this 
region are distinct centres, motor or sensory ; per- 



202 CEREBRAL LOCALISATION. 

sistent — so far as they can be followed — throughout 
the animal kingdom ; and each, in the case of the 
motor centres, presiding over definite groups of 
movements. Let me tell you what these centres 
are, and how they have been identified. 

I. Let us begin with the hindermost convolution 
— the angular gyrus. Electrical stimulation here 
causes movements of the eyeballs, sometimes of the 
head, and very often contraction of the pupils. It 
might be thought that it was a motor centre for the 
eyes. But counter-experiments, in which this area 
of the brain was destroyed by the actual cautery, 
shewed that the movements were only reflex, excited 
by subjective visual sensations (such as occur when 
the retina is galvanised). The eye on the opposite 
side was not paralysed ; but it was blind. Subse- 
quent researches have shewn that this blindness is 
only temporary, as long as the occipital lobes remain 
intact. Such ample provision is even made for this 
important sense, that as long as one occipital lobe 
or one angular gyrus remains, vision persists to some 
degree in both eyes. It is only when all four are 
entirely destroyed that total and permanent blind- 
ness results. 

Some interesting facts relating to hemiopia and 
central vision have come out in the course of this 
enquiry, and may perhaps — if time will allow — 
come before us. At present it must suffice to 
remember that the angular gyrus and the neighbour- 
ing occipital lobe — corresponding roughly to the 
parietal eminence in the skull - — are the cortical 
visual centres. 



HEARING, SMELL, AND TASTE. 2O3 

2. On irritation of the superior temporo-sphenoidal 
convolution in monkeys there is sudden retraction or 
pricking up of the opposite ear, wide opening of the 
eyes, dilatation of the pupils, and turning of the 
head and eyes to the opposite side. These are just 
such phenomena as would occur when a loud sound 
was made in the ear, as indeed was ascertained by 
trial. In the jackal and the rabbit electric stimula- 
tion of the homologous spot caused not only the 
pricking of the ear, but "the quick start or bound as 
to escape from danger, such as might be indicated 
by loud or unusual sounds." On the other hand, its 
destruction by the cautery caused deafness, — on the 
opposite side if made unilaterally, complete if bilat- 
eral. Here, then, we have the auditory centre, at 
the junction of the parietal and squamoso-temporal 
regions of the cranium. 

3. For the sense of smell it was natural to look to 
the subiculum cornu Ammonis, as the olfactory tract 
is very obviously in the lower animals and presuma- 
bly in man connected anatomically therewith. As a 
matter of fact, irritation at this spot was attended by 
a peculiar torsion of the lip and partial closure of the 
nostril on the same side (for the olfactory tracts do 
not decussate), such as a powerful or disagreeable 
odour would excite. Conversely, localised destruc- 
tion here caused diminution or loss of smell. 

4. For similar reasons, the lower part of the mid- 
dle temporo-sphenoidal convolution, which is in close 
connexion with the subiculum, has been identified 
as the seat of taste. The situation of these centres 



204 CEREBRAL LOCALISATION. 

SO near the base of the skull throws light upon the 
loss of taste and smell sometimes following blows on 
the vertex or occiput, where — as you know — the 
chief damage is often done by contre-cotip. That of 
the olfactory centre, moreover, would explain the 
occasional occurrence of anosmia in connexion with 
aphasia and right hemiplegia, where the lesion must 
be close at hand ; and here, as it should be, the anos- 
mia is on the opposite side to the paralysis. 

5. Last, the sense of touch has been found situate 
in what Dr. Ferrier calls the " hiippocampal region," 
including the hippocampus major and the uncinate 
convolution, which it is impossible to separate. It 
is a special satisfaction to have so traced the ultimate 
seat of tactile impressions to the cortical surface, 
for it harmonises with the numerous observations 
lately made in France on hemi-anaesthesia of cerebral 
origin, which has been shewn to result from lesions 
independent of the optic thalami, and to be there- 
fore explicable only on the supposition of a higher 
centre. 

The cerebral seat of all our senses has now been 
made manifest : the " five gateways of knowledge " 
lead to this tract as the throne-room of its palace. 
As in the spinal cord, in the crura cerebri, in the 
basal ganglia, the sensory lies behind the motor 
region : it is as it were the feminine side of the 
nervous system, impressible, perceptive, impulsive, 
keeping in the rear of the stronger actor, whose 
motions nevertheless it plays no small part in deter- 
mining. I pass now to this motor area of the hemi- 
spherical substance. 



THE MOTOR CENTRES. 20$ 

The motor centres lie about the fissure of Rolando, 
being situate chiefly in the ascending parietal and 
frontal convolutions, but including also the postero- 
parietal and the posterior half of the three frontals. 
Thus — proceeding from above downwards — elec- 
trisation of the postero- parietal lobule causes (in 
monkeys) advance of the opposite hind limb, as in 
walking; of the adjoining upper portions of the 
ascending parietal and frontal, complex movements 
of thigh, leg, and foot with — if the electrodes are 
pushed a little forward — movements of the tail; a 
little lower, it induces retraction with adduction of 
the opposite arm ; on the ascending frontal, at its 
junction with the superior frontal, extension forward 
of arm and hand ; all along the ascending parietal, 
prehensile movements of the fingers and wrist ; 
while, down the ascending frontal, there are centres 
for supination and flexion of the forearm, for the 
action of the zygomatics by which the angle of the 
mouth is retracted and elevated, and for elevation of 
the ala nasi and upper lip. At the inferior extremity 
of this convolution, on a level with the posterior ter- 
mination of the third frontal convolution (Broca's), 
stimulation produces alternate opening and closure 
of the mouth, with protrusion and retraction of the 
tongue. These last movements are bilateral, all 
the others having occurred only on the opposite half 
of the body. When, lastly, the posterior half of the 
superior and middle frontal convolutions are excited, 
the eyes open widely, the pupils dilate, and head and 
eyes turn tpvyards the opposite side. 



206 CEREBRAL LOCALISATION. 

For a counter-experiment, let me read you this 
from Professor Ferrier. ''The right hemisphere of 
a monkey had been exposed and subjected to experi- 
mentation with electrical irritation. The part ex- 
posed included the ascending parietal, ascending 
frontal, and posterior extremities of the frontal con- 
volutions. The animal was allowed to recover, for 
the purpose of watching the effects of exposure of 
the brain. Next day the animal was found perfectly 
well. Towards the close of the day following, on 
which there were signs of inflammatory irritation 
and suppuration, it began to suffer from choreic 
spasms of the left angle of the mouth and left arm, 
which recurred repeatedly, and rapidly assumed an 
epileptiform character, affecting the whole of the left 
side of the body. Next day left hemiplegia had be- 
come established, the angle of the mouth drawn to 
the right, the left cheek-pouch flaccid and distended 
with food, which had accumulated outside the dental 
arch ; there being almost total paralysis of the left 
arm, and partial paralysis of the left leg. On the 
day following the paralysis of motion was complete 
over the whole of the left side, and continued so till 
death, nine days subsequently. Tactile sensation, as 
well as sight, hearing, smell and taste, were retained. 
On post-mortem examination it was found that the 
exposed convolutions were completely softened, but 
beyond this the rest of the hemispheres and the basal 
ganglia were free from organic injury." Similar re- 
sults followed destructive experiments localised in 
the special centres ascertained to be such by electri- 
sation. 



SPEECH. 207 

The motor cortical area — the ultimate seat of voli- 
tion — has thus been identified : it lies, as throughout 
the nervous system, anterior to the sensory tract. 
Like that, moreover, it is found to be multiple — to 
consist of a number of separate centres, each presid- 
ing over a definite movement or group of movements. 
How, then, are we to conceive that our will operates.'* 
Has it the faculty of singling out the group of corti- 
cal cells of gray matter through which it must act if 
it desires to execute a given action ? We are con- 
scious, in volition, of no such choice ; nor is it easily 
conceivable. 

Let us go back to our original instance of localisa- 
tion — the power of speech, and its dependence on 
the integrity of the posterior extremity of Broca's 
convolution — the third or inferior frontal. What 
have our experiments in electrisation of the cortex 
taught us about it ? Why, this : that stimulation of its 
immediate neighbourhood excites the movements of 
articulation. Now, if we will think of it, we learn to 
articulate before we begin to attach any meaning to 
words. The baby is taught to say "papa" first of 
all, and then to connect the sound with a gigantic 
being in coat and trousers, whom it individualises so 
little that for some time to come it will address every 
male adult by the name. By degrees, as its educa- 
tion proceeds, we may conceive two processes as 
going on in its sensitive and plastic brain. An 
organic nexus is being formed there between sights, 
tastes and other sensations and the sounds used to 
express the objects arousing them ; and further, each 



208 CEREBRAL LOCALISATION. 

act of articulation is impressing on the cells which 
originate it a material memory — as it were, which — 
after a time — is revivable at will or on incitement. 
Speech, then, — the power of retaining and recollect- 
ing words, and associating them with ideas — is the 
subjective side of articulation. Let the centre at 
which the movements requisite for the latter have 
become organised be damaged, and the faculty itself 
is lost : there is no store for recollection to draw upon, 
no excitable spot at which the process of retention 
can be recommenced. The associations with words 
remain, when these are supplied ; for they are regis- 
tered on the sensory centres, which — like the sensi- 
tised plate of the photographer — receive them for 
ever, and recall them in ideas and emotions. 

And now we can see why it is on the left side of 
the brain that the faculty of speech comes to be 
seated. It is so because it is the result of the mus- 
cular actions of articulation. We have seen these to 
be performed bilaterally, though the excitation has 
been given to one hemisphere only. Potentially, 
therefore, the impulse to speech might have pro- 
ceeded from either side, and been organised there 
accordingly ; but actually, that education of the right 
arm which we are taught to practise from our early 
days so developes the left half of the brain that the 
other lies comparatively idle. We know how difficult 
it is, when right hemiplegia has occurred, to get the 
left hand to execute the required movements — as in 
writing. For those, yet more delicate and complex, 
involved in speech the task is so hard as to be imprac- 



SPEECH. 209 

ticable, — at any rate at first. There are cases on 
record, however, in which — though the paralysis per- 
sisted — the power of speaking gradually returned; 
and here we may fairly conceive the right speech- 
centre as taking up the duty. 

A crucial test of the soundness of this explanation 
would be afforded by the behaviour of a man natu- 
rally left-handed when affected with hemiplegia, for 
with him aphasia should accompany it only when on 
the left side. Ferrier can refer to three cases in 
which this coincidence has been observed. And per- 
haps the practical inference is that which our recently 
deceased English novelist — Charles Reade — la- 
boured so much to impress, — that we should all en- 
deavour to be ambidextrous. Besides the advantasres 

o 

he urged, we should, if ever the misfortune of a par- 
alytic stroke came upon us, have an arm and hand 
already educated to do our necessary work ; and, on 
whichever side it fell, we should preserve our speech 
unimpaired. 

The will to speak is thus the revival, from some 
sensory excitement, felt or reawakened, of the activ- 
ity of the corresponding motor centre, and it thus 
inevitably performs itself in speech. We do not 
direct the volition to Broca's convolution, which we 
should find it hard to do : it is there that it originates, 
and when we say we " will," we mean our conscious- 
ness of such awaking. But are all our actions, you 
will ask, thus mechanically organised, so that on sen- 
sation, emotion or idea same habitual action necessa- 
rily follows } Not so, or we should not be moral 



210 CEREBRAL LOCALISATION. 

beings. There are, in many parts of the nervous 
system, bundles of fibres whose function we describe 
as inJdbitory. They are themselves motor in power ; 
but their office is — doubtless through their connex- 
ions — to restrain such action as would otherwise 
result from the influence of their fellows. Thus the 
pneumogastric — or rather the spinal accessory fibres 
which run in it — is the inhibitory nerve of the heart: 
stimulate it, and you retard the pulse-rate ; divide it, 
and the organ bounds off like a hound slipped from 
its leash, and palpitates at breathless speed. Now 
of such inhibitory power over our impulses to action 
we are certainly conscious, and there is a portion of 
the cerebruiTi as yet unassigned in which probably 
the power resides. The frontal lobes, as you will 
have already noticed, project beyond the motor as 
the occipital lobes beyond the sensory area. Stimu- 
lation of neither produces any positive effect, nor does 
any very appreciable result follow their destruction. 
So far as can be judged, however, in creatures which 
have no faculty of expression, the occipital lobes are 
the seat of visceral sensations ; while the removal of 
the frontal lobes converted rather " bright " monkeys 
into apathetic ones, wanting in the faculty of attentive 
and intelligent observation. Now ethical enquirers 
have always perceived, when they have thought out 
the matter, that our moral responsibility lies in our 
faculty of exercising attention. Self-control is the re- 
sult of its use. In refusing to act upon mere impulse, 
or upon base motives, we are not unimpelled, without 
motive. Ideas and emotions — themselves the prod- 



THE FRONTAL LOBES. 211 

uct of past sensations — still govern us ; but we have- 
chosen to which of them we will attend — which, 
therefore, shall influence our actions. There are two 
ways in which, conceivably, we might do this, — one 
being by the stimulation of the current of ideas we 
wish to encourage, the other by the repression of 
those we would refuse. The latter is the more prob- 
able alternative; and if, physiologically, the anterior 
part of the brain. be an inhibitory centre, then, psy- 
chologically, it is our organ of attention. It is that 
by which, in obedience to some higher motive, we 
check the natural impulses to action. It is the or- 
ganic seat of that which is the distinctively human in 
us, and accordingly is far more developed in 'Mioc ani- 
mal quem vocamus homo" than in any other. In pro- 
portion as its powers are educated, we become men 
of discriminative judgment and deliberate choice : the 
merely natural becomes less in us, and the moral 
more : we 

" move upward, working out the brute, 
And let the ape and tiger die." 

It is not without foundation, then, that common 
observation has connected the development of the 
frontal lobes, and the expansion of the forehead, with 
the large growth of the truly human in man — with 
breadth of intellect and moral strength ; while bulk 
of the occipital lobes would indicate predominance 
of the animal. And one great encouragement which 
cerebral physiology gives us is the indefinite capaci- 
ties of education it shews our brains to possess. 
Happy they who from childhood up have been 



212 CEREBRAL LOCALISATION. 

trained to be no mere creatures of impulse ! But 
they who from any cause have missed this early 
nurture can do much for themselves to cultivate the 
inhibitory faculty, and thereby to conduce to their 
own happiness and that of all with whom they have 
to do, — to say nothing of higher ends. 

It will not have been amiss, ladies and gentlemen, 
that this discussion of the psychical should have led 
us to the confines of the ethical, and should have 
given us a glimpse into the borderland. I am sure 
that all your teachers here, much as they desire for 
you to be masters of knowledge, are yet more ear- 
nest in their wish that you should be loyal servants 
of Duty. 



X. 



CEREBRAL LOCALISATION AND DRUG-ACTION 

{continued). 

I PROMISED that, at our next meeting, I would 
enter into some of the anatomical, pathological, and 
clinical facts connected with cerebral localisation, 
and so lead on to its connexion with drug-action. I 
proceed now to redeem my promise. 

I. Let me first remind you of some facts to which, 
during your studies in anatomy, your attention must 
have been strongly directed, viz. : the distribution of 
the arteries of the brain. These are, you will re- 
member, the internal carotid and the A^ertebral. 
The internal carotid divides into two main branches 
— the anterior and the middle cerebral ; while the 
basilar artery, which results from the union of the 
two vertebrals, becomes double again in the shape of 
the two posterior cerebrals. Take now this semi- 
diagrammatic view, which our artist has copied from 
the Lectures on Cerebral and Spinal Localisation by 
Professor Charcot, of Paris, which have lately been 
translated for the New Sydenham Society. It ex- 
hibits the ramifications of the middle cerebral or 

213 



214 



CEREBRAL LOCALISATION. 



Sylvian artery (so called from its entering at the Syl- 
vian fissure). You will see at a glance that the re- 
gion supplied by its anterior branches is just that 
which experiment has marked out as the psycho- 




motor area (this is our author's name for the motor 
portion of the cortex cerebri) ; that its distribution 
explains why the posterior portion of the three 
frontal convolutions should be functionally different 
from the remainder (v/hich is supplied by the anterior 



THE SYLVIAN ARTERY. 215 

cerebral) ; and that aphasia may well exist alone, 
since Broca's convolution has a branch to itself. 
Let this be plugged by an embolism, and atrophy 
of the seat of speech may be the sole lesion, sud- 
den aphasia the sole result. This actually occurred 
in a case observed by Charcot at the Salpetriere. 

The posterior branches of the artery, you will 
observe, reach the angular gyrus and the temporo- 
sphenoidal convolutions, which have been ascer- 
tained to be the seat of the senses of sight and 
hearing, which through the circulation therefore — 
as well as (doubtless) through innumerable commis- 
sural nerve-fibres — are associated with the motor 
centres. But remember that the posterior cerebral, 
besides its chief work of supplying the occipital lobes, 
sends branches also to the temporo-sphenoidal region, 
to the gyrus uncinatus, and to the hippocampus. 
As you will remember that there is somewhere in 
the occipital lobes a supplementary visual centre, 
there are some features here suggesting special pro- 
vision for the integrity of regions which are the seat 
of our conscious sensations, and thus of our ideas. 

2. Again, I must anticipate morbid anatomy so 
far as to say that, when the psycho-motor area of 
the brain is seriously affected — as with softening, 
a peculiar degeneration — a sclerosis — is found to 
descend therefrom through certain definite tracts 
of the spinal cord. These are the small columns 
called (after the first observer of these degenera- 
tions) Turck's, which lie immediately beside the 
anterior median fissure, and a certain portion of the 



2l6 CEREBRAL LOCALISATION. 

lateral columns. Such tracts, therefore, must be 
regarded as the true prolongations of the fibres 
coming off from the motor cerebral cells and pro- 
ceeding down the crura ; the rest of the spinal fibres 
being (longitudinally) commissural. Now it is an 
interesting fact that these cerebro-spinal fibres are 
latest in development, — that their axis-cylinder 
(which you know is the central and essential part of 
the nerve-fibre) has not acquired its myeline sheath, 
and so is not insulated for action, at birth. This is 
ascertained by treating the cord of the newly-born 
child with osmic acid, a substance which gives a 
black stain to the sheath — the white substance of 
Schwann, as we used to call it, but leaves the axis- 
cylinder clear. Those parts, I say, which in para- 
lysing cerebral lesions are affected with descending 
sclerosis, are just the parts which remain clear under 
the osmic acid. The true spinal cord of the infant 
is already fully developed, as also his medulla ob- 
longata, for these are the seat of the automatic reflex 
activities it immediately requires. The fibres which 
convey impressions to and from consciousness are 
not yet needed. The cerebrum itself is in the same 
rudimentary condition, — its main structural details 
barely outlined, and the nerve-tubes almost univer- 
sally absent. Moreover, in the young of those ani- 
mals which are born blind, and which therefore — 
like the human infant — are at this time mere reflex 
automata, electrical stimulation of the excitable poi:- 
tions of the cortex determines no movements. It 
does so in animals which are born with open eyes, 



THE GRAY CELLS. 21/ 

and the histological development and chemical con- 
stitution of the cerebrum of these creatures differs 
little from the condition which obtains in the adult 
state. 

3. Anatomy can go even farther still — into the 
realm of histology, and still find facts confirmatory 
of the doctrine of cerebral localisation. It was long 
ago noticed (I mentioned it in an account of the 
nervous system which I contributed to the Britisli 
Jouiiial of Homoeopathy in 1861) that the gray cells 
of the anterior cornua of the cord — whence, as you 
know, the motor roots of the spinal nerves take 
their origin — were considerably larger than those in 
the posterior cornua, which are sensitive. Now of 
late the cells of the gray matter of the brain have 
been examined microscopically, and similar differ- 
ences have been found to obtain. In front of the 
fissure of Rolando cells so large as to be called 
"giant" are to be found, and they are especially 
massed about this sulcus, i.e. in the neighbouring 
parts of the ascending parietal and frontal convolu- 
tions — the great motor area. Behind this spot, in 
the sensory region of the brain, the cells — the femi- 
nine cells, you will remember I called them — are 
markedly smaller, though still superior to those of 
the cerebellar hemispheres. 

4. I now come to the bearing which pathological 
anatomy has upon our present subject, and in this 
part of my task am more than elsewhere indebted 
to Professor Charcot's lectures. 

If the inferences drawn from physiological experi- 



21 8 CEREBRAL LOCALISATION. 

ment are correct, disease — as from softening due 
to embolism or thrombosis occluding the anterior 
branches of the middle cerebral artery — affecting 
the psycho-motor area should cause hemiplegia, even 
though the corpora striata remained untouched. 
This corollary has been abundantly warranted by 
experience. Charcot has recorded all the cases of 
ischDsmic softening of the cortex of the hemispheres 
dying in his wards in the Salpetriere during the last 
fifteen years. 

" In these cases " he writes " the lesion presented itself under 
the form of yellow softening {plaques jmines), more or less 
extensive in area, involving to a variable depth the subjacent 
white matter and occupying the most diverse regions of the 
surface of the hemisphere. It is expressly mentioned in all 
the observations that the softening had not affected the central 
masses — optic thalami, corpora striata, and internal capsule. 
My observations may be divided into two groups. 

" The first includes the cases in which permanent hemiplegia 
had not existed during life, and in which secondary degenera- 
tion was found at the autopsy to be absent. 

" In all, the convolutions supplied by the Sylvian artery, and 
particularly the ascending frontal and parietal, remained intact. 
The yellow softening was situated in one of the following re- 
gions, viz.; some part of the sphenoidal lobes, the lobulus quad- 
ratus, the cuneus, one or both occipital lobes in their entirety, 
some part of the anterior two-thirds of the frontal lobes. 

"In all the cases of the second group there had been, on 
the other hand, permanent hemiplegia and well-marked sec- 
ondary sclerosis. The feature common to these cases is that 
the lesion invariably involved, to a greater or less extent, one 
or other of the ascending frontal and parietal convolutions, 
principally in their upper half, and often both at the same time. 
In addition, the regions nearest to the frontal and parietal con- 
volutions were very frequently involved." 



219 

This should be enough. Here is no single case, 
which might be exceptional and neutralised by others 
of opposite significance ; but a series of observations 
in a large special hospital extending over fifteen 
years, and all concurring — positively or negatively 
— in the same conclusion. The statement made by 
Nature in answer to experimental enquiry is volun- 
teered by her of her own accord. 

Let me now say something of this " descending 
sclerosis," which has more than once come before us. 
It consists, as I mentioned, in an indurative degen- 
eration of those tracts in the spinal cord which are 
direct prolongations from the brain — the columns of 
Turck and the outer and posterior border of the lat- 
eral columns. The former are not crossed, and do 
not penetrate very far ; the latter are continuous with 
the decussating fibres in the anterior pyramids of 
the medulla oblongata, and are altogether so much 
more important a factor in the matter that the whole 
thing is called " lateral sclerosis." This morbid pro- 
cess, in its secondary descending form, will follow 
any lesion of the motor tract, from the white sub- 
stance of the hemispheres downwards, which inter- 
rupts the contiliuity of its fibres. It does not follow 
upon hemiplegia consequent on mischief limited to 
the corpus striatum ; which appears to shew that this 
body is a ganglion ancillary to motor agency, rather 
than a secondary centre to which the whole tract 
converges to radiate forth again. 

The explanation of this secondary degeneration is 
derived from the phenomena which occur when a 



220 CEREBRAL LOCALISATION. 

nerve is separated from its centre. When the mixed 
spinal nerves are divided, the peripheral end degen- 
erates, both in its centripetal and its centrifugal 
fibres. But when it is — as it were — unravelled by 
ascending to its roots, a different result is obtained. 
When the anterior root is divided, its peripheral 
end is still that to wither. The motor centres of 
these roots are thus (as we shall see from other facts) 
their trophic centres also, viz. : the cells of the ante- 
rior cornua of the cord. But divide the posterior 
root — which you must needs do before you get to 
the ganglion which you know exists upon it, at its 
junction with the anterior ; divide this root at any 
point, and it is the central end which withers — the 
peripheral remaining intact. The ganglion, then, 
whose presence in my student-days anatomists used 
to consider somewhat of an impertinence, is now 
shewn to be the trophic centre of the sensory root, 
— nay, of the whole sensory nerve ; for extirpate it, 
and degeneration attacks not only the posterior root, 
but all the centripetal fibres of the mixed nerve. 

Lesions of continuity of the cerebral motor tract 
thus cause degeneration below their seat, because 
they cut off the fibres descending therefrom from 
their trophic centre, which is the psycho-motor area 
of the cortex. What symptoms do they cause ? 
Two only, invariably : loss of power and contracture 
of the limbs. These are usually and mainly seen on 
the opposite side of body to the lesion ; but some- 
times or to some extent on the same, — the latter 
being accounted for by the involvement of the col- 



*'LATE RIGIDITY. 221 

imins of Turck, which — as I have mentioned — are 
not crossed. Now this contracture of the limbs is a 
phenomenon in every way of great interest. It has 
long been known as a symptom of much import in 
the prognosis of hemiplegic attacks. "Early rigid- 
ity " means little, as it may result merely from irri- 
tation, as about a clot; but "late rigidity" — that 
which supervenes some months after the " stroke " 
— implies that the paralysis is going to be perma- 
nent. Dr. Todd ascribed it to cicatrisation of the 
brain at the injured spot ; but the descending degen- 
eration since discovered is more of a vera causa, as 
amply accounting for the impossibility of recovery. 

The lateral sclerosis, nevertheless, explains only 
the paralysis in these cases : but wdiat is the cause of 
the contracture 1 This, it would seem, must be 
something of a functional rather than an organic 
nature, for this reason, that the rigidity is not uni- 
form and constant. It relaxes somewhat during rest 
and sleep ; it is increased on movement, and espe- 
cially by anything like exertion (I mean of course 
on the healthy side) ; its appearance may be antici- 
pated, or its intensity enhanced, by the administra- 
tion of strychnia, while opposite results follow large 
doses of bromide of potassium. Now what these 
agents increase and diminish respectively is the re- 
flex excitability of the spinal cord ; and, looking 
farther in the direction thus suggested, we come 
across some very interesting facts. There is a symp- 
tom, present in certain kinds of paralysis, absent in 
others, to which the Germans have given the name 



222 CEREBRAL LOCALISATION. 

of *' foot-phenomenon " or "ankle-clonus" — the lat- 
ter being its usual designation in England. It is eli- 
cited by supporting (as with the hand under the ham) 
the paralysed leg, so that it may hang loose and swing. 
Then, if the point of the foot be suddenly raised, "a 
series of shakes is at once provoked, which collec- 
tively constitute a kind of rhythmical movement or 
oscillatory trembling more or less regular and per- 
sistent " (Charcot). Now in the healthy subject 
this "spinal trepidation," as the French call it, can- 
not be produced, and it is absent in such affections 
as locomotor ataxy and infantile spinal paralysis ; 
but it is present in all paralyses in which contracture 
exists and tends to be established. In hemiplegia of 
cerebral origin, it often precedes the " late rigidity " 
by some weeks : it is thus of value for prognostic 
purposes, and it further throws light upon the nature 
of the symptom it heralds. For it evidently belongs 
to the group of phenomena known as " tendon-re- 
flexes," of which the starting forward of the leg on 
striking the patellar tendon is the most familiar ; and 
these, as their name implies, are reflex actions. If 
the ankle-clonus, then, absent in health, is present 
in paralysis with contracture, it implies that in this 
condition the reflex excitability of the cord has 
undergone enhancement, i.e. (as there are no sensory 
phenomena here) that the cells of the anterior cornua 
are in an irritable state. What should induce them 
to be so } This question is probably to be answered 
by considering the destination of the cerebro-spinal 
lateral fibres — the "pyramidal tracts," as Charcot 



"TENDON-REFLEXES. 223 

calls them. They progressively diminish in size from 
above downwards, are ''used up" — as it were — in 
the course of their descent. They convey the orders 
of the will to the motor nerves, and yet there is de- 
monstrably no continuity between them and the ante- 
rior roots.' What remains, then, but that they end in 
the cells of the anterior cornua, from which the motor 
roots emerge ? If they do so, then it would seem 
that — in descending sclerosis — these cells must 
either take on the process of degeneration, or must 
oppose it. That they do not ordinarily accept it ap- 
pears from the fact that " the muscles of the extremi- 
ties on the paralysed side in patients affected with 
permanent hemiplegia of cerebral origin present no 
other atrophic changes than those resulting very 
slowly from the functional inertia to which these 
muscles are condemned " (Charcot). Did the ante- 
rior cornual cells suffer, rapid muscular atrophy 
would follow, as indeed occurs in the acute disease 
known as anterior poliomyelitis (of which infantile 
spinal paralysis is an example) and in the chronic one 
we call '* wasting palsy " — the " progressive muscular 
atrophy " of Duchenne. Sometimes, in ordinary hemi- 
plegia, this ''amyotrophy" does occur, and the cells 
of the anterior cornua have been found to have suc- 
cumbed ; ^ but more commonly, as I say, they resist. 
Now resistance implies over-action, irritation. Given 
an irritable state of the cells of the anterior cornua, 
and you have the exaggeration of reflex activity 
shewn in the ankle-clonus, you have the exaggera- 

^ See Charcot, op. cit.^ p. 299. ^ Charcot, op. «/., p. 201-3. 



224 CEREBRAL LOCALISATION. 

tion of the normal muscular tone which appears as 
contracture. 

The point of special value to us here is that such 
a condition is, as Charcot says, "purely dynamic and 
corresponds to no appreciable anatomical modifica- 
tion." Hence its variability under circumstances ; 
and hence (a point I have not yet noted) its occa- 
sional diminution and even disappearance in the 
course of time. Now all this brings it into the thera- 
peutic sphere. We have seen that contracture may 
be anticipated or intensified by strychnia so given as 
to induce its physiological effects. Hence the warn- 
ings of old against using Nux vomica or its alkaloid 
in cerebral hemiplegia; but hence, obviously, the 
indication for them to us, in our non-physiological 
doses. Even in the old school Mr. Charles Hunter 
finds that by reducing his dose of hypodermic strych- 
nia to the sixtieth or eightieth of a grain he can 
remove "the muscular twitchings, spasms, or cramps 
of the paralysed parts ;" and these are just the vari- 
able element in contracture, and one chief source 
of its irksomeness. We cannot (probably) by drug- 
treatment alter the sclerosis, and so cannot restore 
power; but it will be no slight help to our patients 
if we can further the natural possibilities of mitiga- 
tion or subsidence of rigidity. Let me also remind 
you that if at any time a sudden accession of wasting 
— with loss of electric contractility — should occur 
in the paralysed muscles, indicating commencing 
degeneration of the cells of the anterior cornua, we 
have a hopeful remedy in Plumbum. Lead-palsy is 



PLUMBUM IN AMYOTROPHY. 225 

the precise analogue in drug-disease of progressive 
muscular atrophy; and even in what may be called 
the acute form of that affection — in anterior polio- 
myelitis — the drug would seem effective. Dr. Jous- 
set has recorded — in his Lecons dc Cliiiiquc ]\Iedicalc, 
which Dr. Ludlam has done such good service by 
rendering into English — an undoubted case of the 
kind, in which Plumbum (in the 30th dilution) ef- 
fected a cure.' 

All this about ''late rigidity" has been somewhat 
of a digression ; but I think it warranted by the 
frequency with which cerebral hemiplegia will come 
before you in practice, and the desirableness of your 
knowing all that can be known about it. I return 
now to the more direct thread of our discourse ; and 
proceed to say something of the clinical aspects of 
cerebral localisation. 

5. If it be so, that certain spots in the cerebral 
cortex are the seat of definite functions, sensory or 
motor, ought not the knowledge of them to be of aid 
to surgery 1 If symptoms of pressure on the brain 
exist after an injury, or of localised irritation where 
an exostosis or other morbid growth may fairly be 
presumed to exist, would not the surgeon be justified 
in trephining the skull at the point indicated by the 
functional disorder } This question was largely dis- 
cussed in Paris during the years immediately follow- 
ing the researches of Fritsch, Hitzig, and Ferrier, 

^ Cuprum, I maj' add, is p.nother medicine wliich lias amyotrophy among 
its effects, and also something very like contracture (see my Thcra^cniics, i. 
236). 



226 CEREBRAL LOCALISATION. 

especially in 1877, when the French medical journals 
were full of it. On the whole, the verdict was in 
the negative. In injuries, the old rule of trephining 
(if at all) at the seat of the wound seems still to be 
the safest ; while, in the case of morbid growths, 
the pressure they exert is so diffused as to make it 
almost impossible to identify their exact seat. You 
know, for instance, how often they cause optic neu- 
ritis, without interfering in any obvious way with 
the integrity of the optic tracts. All this is true, 
but I think that an exception might be made in the 
case of presumed exostosis. If troublesome symp- 
toms — epileptic or otherwise — were present, and 
the history of the case raised a reasonable proba- 
bility of such a growth being their cause, I would 
strongly advise the application of the trephine at the 
'spot to which the symptoms pointed. As the dura 
mater need not be opened here, the operation would 
involve little risk — the usual precautions being 
taken ; and sometimes a deliverance otherwise im- 
possible might ensue. 

6. Of yet more interest, to most of us, are the 
phenomena which clinical medicine presents in this 
sphere ; and they have the further recommendation 
that some of them at least suggested the doctrine 
of cerebral localisation before physiological experi- 
ment had established it. I refer to the observations 
of Dr. Hughlings Jackson, of London. I wish that 
this philosophical physician would do himself the jus- 
tice and us the benefit of collecting his scattered 
contributions on the subject to journals and transac- 



HUGHLINGS JACKSON. 22/ 

tions into one work. Dr. Ferrier spoke of him as 
doing' so in 1876; but the promised "Clinical and 
Pathological Researches on the Nervous System " 
have not yet seen the light. Dr. Jackson was struck 
with the unilateral and localised forms sometimes 
presented by epileptic convulsions. On the theory of 
the disease being resident in the medulla oblongata, 
the whole frame should be uniformly convulsed. The 
limitation often seen to one side of the body disal- 
lowed this conception, at least in such cases, and 
compelled that of a direct discharge of nerve-force ; 
while again the involvement only of the arm, or leg, 
or certain of the facial muscles prevented reference 
to the gray matter of the corpus striatum, lesion of 
which influences the whole of one side of the body. 
Thought was thus inevitably carried up to the hemi- 
spheres, and he drew the inference that the convo- 
lutions surrounding the striate bodies had a direct 
relation to movements, — the convulsive phenomena 
being the result of irritative or "discharging " lesions 
of the cortex in this region. 

In several places he has explained his views about 
these " discharging " lesions. He distinguishes them, 
by this name, from "paralysing" lesions: they are 
to one another as electrisation of the cortex to de- 
struction of the same spot in physiological experi- 
ment. The discharging lesion, like the former, 
causes over-action ; not better function, but " insta- 
bility " of the gray matter in its neighbourhood, lead- 
ing to frequent, involuntary, violent exercises of its 
influence. If it be a motor centre, this will result 



228 CEREBRAL LOCALISATION, 

in localised convulsion ; if a sensory one, in some 
subjective manifestations of its form of sensibility. 
The first is easy of conception : to illustrate the 
second, let me read you the narrative of a case com- 
municated by Dr. Gowers to the Lancet of 1879. 

" The patient " who was a man of about 30 '' stated 
that he was well until two months before he was first 
seen, when one morning something seemed very bril- 
liant before him, ' as if he had a polished plate on his 
breast.' He felt giddy, but did not fall ; he sat down, 
bathed his head, and was better, but afterwards felt 
extreme pain in his eyes, 'as if they were bursting.' 
Subsequently, he had slight attacks daily, of the 
following character : A pain commences in the neck, 
goes across the head, comes down between the eyes, 
and is felt on each side of the bridge of the nose. 
If walking, the road or path seems to get narrower 
and narrower, so that he hardly knows where he 
is going, and simultaneously his sight fails; he feels 
with a stick to see if he is not getting off the path. 
The pain at the top of the head and in the eyes 
is something awful, and the eyes seem to throb. 
The loss of sight is not complete ; he can only see 
just before him, nothing on either side ; but he can 
generally see better to the right than to the left. 
During the three days before he was first seen, at 
•the commencement of the attacks, as the sight was 
going, he had a flickering of light, ' like a gold ser- 
pent,' in the eye, moving in all directions very fast ; 
seen with both eyes, he thought, but more before the 
left eye than the right. 



"DISCHARGING LESIONS. 229 

*'He was treated with bromide and belladonna, 
and the attacks ceased, except that once or twice he 
had a slight flickering before the eyes. He had, 
moreover, several attacks of pain on the top of his 
head, coming on suddenly, and he often had pain 
at the back of the neck." 

After continuing well for five months, this man 
had a fall, striking the head. General symptoms of 
cerebral disturbance followed, and he died comatose. 
At the autopsy, a large tumour was found in the 
right occipital region, invading the angular gyrus. 
Now this convolution, you will remember, is the 
special seat of the sense of sight. The neighbour- 
ing tumour acted as a discharging lesion to it and 
caused instability of its gray matter. Hence the 
paroxysms, so to speak, of subjective visual sensi- 
bility — at first exaggerated, later diminished. Ob- 
serve, further, the effect of treatment in removing, 
almost absolutely, this part of the trouble ; so that 
while the tumour remained, it could no longer cause 
morbid discharge of the gray cells in its vicinity. 
Does not this remind one closely of lateral sclerosis 
of the cord and the contracture caused by the irrita- 
tion of the anterior cornua ? Here, as there, the 
inference is therapeutically encouraging : part of the 
patient's trouble is functional only, and may be re- 
moved by medicines. Of those actually used, the 
combination spoils the effect for any clinical infer- 
ences ; and indeed is an unusually strange one. A 
bromide simply dulls all sensibility, morbid or 
healthy ; but why Belladonna ? If this had been 



230 CEREBRAL LOCALISATION. 

given alone, we should have called the cure a beau- 
tiful piece of homoeopathy ; for no drug causes so 
much visual hallucination, and this patient's can be 
exactly paralleled from its pathogenesis. One of 
Hahnemann's provers, Kummer, who evidently ex- 
perimented on a very sensitive woman, gives among 
her symptoms — " she sees on the ceiling of the 
room a white star as large as a plate, and light silver 
clouds pass over it from left to right." This oc- 
curred several times and in various places. We 
should certainly give Belladonna when discharging 
lesions affected the visual centres, and might expect 
the best results. 

I would direct your attention, before leaving this 
case, to the seat (or seats) of the pain experienced. 
This was evidently connected with the visual excite- 
ment, and yet we know that the optic tract itself 
has no common sensibility. As this is supplied to 
the eyeballs by the fifth nerve, and as it was in them 
that the pain was first experienced, we might sup- 
pose the commencement of the feeling at the back 
of the neck to be connected with the origin of this 
nerve at the base of the brain. But why the going 
across the head ? and why the subsequent sudden 
attacks of pain "at the top of the head".? This I 
cannot say ; and the angular gyrus, you are aware, 
corresponds rather to the parietal protuberance. 
But I remember a case of brain-fag in which I was 
consulted, and where one of the symptoms was great 
sensibility to light. The patient said that when he 
drew up his chamber-blind in the morning, and the 



"SENSORY CONVULSIONS." 23 I 

sun happened to be shining brightly, a sudden pain 
struck through his eyes to the top of his head. (I 
may mention that this symptom, with the visual sen- 
sitiveness in general, disappeared under Nux vomica 
30.) Whatever it means, then, I think we may hold 
— provisionally at least — that the pain which the 
optic tract cannot feel for itself will be referred to 
the vertex. 

Dr. Hughlings Jackson has described cases of lim- 
ited paralysis and convulsion as '' the results of ex- 
periments made by disease on particular parts of the 
nervous system of man." A case of this kind, which 
displays a sort of sensory convulsion, is such an ex- 
periment, and it is full of instruction. It suggests 
the meaning of such as those we often encounter, 
where one or more epileptiform attacks occur in a 
man to whom they have been hitherto unknown, and 
where there is no syphilitic hi.story to suggest exos- 
tosis, and then are followed by sudden hemiplegia. 
Here some lesion, probably a small aneurism in a 
cerebral artery, has first by its irritating presence 
caused discharge in its neighbourhood ; and finally, 
giving way, has become paralysing to the same spot. 
Again, it throws great light upon the '*aura epilep- 
tica." You know that epileptics frequently experi- 
ence, as premonitory to their paroxysm, a sensation of 
some kind, — a sight, a sound, a smell, a taste, or the 
*' aura " strictly speaking — a feeling as of a breath 
of cool air along a limb. In all cases, the sensation 
becomes more intense as the fit draws on, and — if its 
nature allow — will seem to be approaching the brain. 



232 CEREBRAL LOCALISATION. 

The aura will ascend the limb, the supposed object 
of sight will advance. A patient of mine used to see 
a pair of white wings drawing rapidly nearer to her 
from the other end of the room, and as they reached 
her she lost consciousness, fell, and became con- 
vulsed. In the licrht of what we have learned it is 
evident that this means a state of instability of some 
sensory centre, leading to recurrent discharges, which 
ultimately affect the motor apparatus, but first shew 
themselves in the sensations proper to its own en- 
dowments, — these being, by a well-known law, re- 
ferred to the periphery first of all or undergoing a 
corresponding increase in intensity. Sometimes, in- 
deed, the aura (not then strictly to be so called) is 
motor from the outset, and consists in twitching — 
say — of a thumb or finger of the arm which is ulti- 
mately the main seat of convulsion. 

When these auras were first studied, the idea of re- 
flex action was dominant, and it was supposed that 
somethmg could be done by dividing nerves along 
which they seemed to proceed, or forcibly compress- 
ing the limb above them. No constant result fol- 
lowed these attempts, and we see how it must have 
been so. They were but peripheral expressions of 
central irritation. If anything was done, it was by 
indirectly modifyi'ng this ; and such practice must be 
very uncertain. We should have a much surer and 
finer road to the affected part if we possessed drugs 
which have shewn themselves capable of arousing 
similar subjective sensations. When any such symp- 
toms have occurred in pathogenesy, we should note 
them, and may be able to turn them to good account. 



CARBOLIC ACID IN HVPEROSMIA. 233 

For instance, Carbolic acid has shewn a power of 
enhancing the olfactory sensibility. In two of its 
provers this occurred from simply smelling at the 
acid ; it was associated with the frontal headache of 
the drug, and — when it once came on — lasted for 
hours. In another it resulted from involuntary ex- 
posure to the vapour, and was intense, making the 
presence of any odorous matter intolerable. In a 
case I have myself observed, a prolonged inhalation 
caused all food to smell badly for weeks after. Well : 
it was perhaps a small matter that this symptom en- 
abled me to remove with the drug a frequently-recur- 
ring headache in a lady not subject to such trouble. 
There was nothing distinctive about the pain ; but, 
she said, whenever it comes, everything seems to 
smell too strong. Carbolic acid 12 rapidly and per- 
manently checked the attacks. But, on another oc- 
casion, a clergyman consulted me with this story. 
He had been in fair health till some months previ- 
ously, when he had incurred measles. On recovering 
from this, everything with any odour had begun to 
smell disagreeably to him. This had increased to 
such a degree that he could not take adequate food 
from the disgust it caused him : he had lost many 
pounds in weight, and was getting weak. It was not 
a case of ozasna, for there was no discharge from the 
nostrils, and no offensive odour of the patient's breath 
or nasal mucus. I could only conceive that the 
morbillous catarrh had in some way affected the ol- 
factory nerves ; and I prescribed Carbolic acid. As 
he said that he was an old homoeopathist, and very 



234 CEREBRAL LOCALISATION. 

sensitive to medicinal action, I gave him the 30th. 
At the end of a week he reported improvement ; and 
in three weeks time he had lost all his bad smell, 
and was enjoying his food like any other man. 

Now with this action of Carbolic acid, thus ob- 
served and thus verified, if we had a case of epi- 
lepsy in which the premonitory symptom was a 
subjective odour, I think we should be justified in 
expecting the best results from it. 

At our next meeting I shall hope to draw out 
more fully the possibilities of drug-action in con- 
nexion with the localisation of nervous function. 



XL 



CEREBRAL LOCALISATION AxND DRUG ACTION 

{coniifiued). 

Several times already, in our study of cerebral 
localisation in its pathological and clinical aspects, 
we have touched upon its connexions with drug- 
action. This evening I propose to concentrate your 
attention on this branch of the subject. It is that 
which especially belongs to us of the homoeopathic 
school ; and we are disposed to maintain that it is 
at least not inferior in importance to any other. We 
frankly acknowledge the industry and acumen with 
which the subject, at large has been worked out by 
our brethren in the other camp; but, save for prog- 
nosis, and for an occasional tentative surgical opera- 
tion, they must feel that the knowledge gained has 
done little for therapeutics — that one great end of 
the physician. Let it be ours to emulate their zeal 
and to utilise their results by seeking to make them 
fruitful in this direction. The law of similars ena- 
bles us to do this. We have acquired a better 
understanding of a group of morbid phenomena : 

let us find parallel facts in the physiological action 

235 



236 CEREBRAL LOCALISATION. 

of drugs, and unlimited possibilities open to us in 
the way of benefit. 

I. I have spoken of Hughlings Jackson's "dis- 
charging lesions" — of those which cause instability 
and morbid outbursts of function on the part of the 
gray matter in their vicinity ; and have shewn that 
this instability, being a purely dynamic disturbance 
— an irritation, ought to be under medicinal control. 
We have seen two instances of it, — the twitching, 
cramps, spasms of paralysed limbs, ultimating in 
permanent contracture, which arise from the effect 
on the cells of the anterior cornua of lateral sclerosis 
of the cord; and the subjective visual disturbances 
resulting from a tumour adjoining the angular gyrus. 
In the latter case Belladonna, which would have 
been our own remedy, was one of the drugs admin- 
istered with good effect : in the former Strychnia, 
known to increase the symptoms, and obviously 
homoeopathic to them, has already acquired some 
repute against them, and in our hands may fairly be 
expected to accomplish more. 

I. Looking farther in the same direction our atten- 
tion may be drawn to the disease known as loco- 
motor ataxy — the "tabes dorsalis " of Romberg, 
who was the first to describe it. The clinical history 
of this spinal affection you have doubtless learned 
from your teachers, and I will only go over the 
ground again so far as to remind you of a point in 
its pathology. It used to be spoken of as a sclerosis 
of the posterior columns of the cord. But localisa- 
tion has been at work here also, and has shewn that 



LOCOMOTOR ATAXY. 237 

under this anatomical name there are comprised at 
least two distinct tracts of nerve-fibres. The one 
pair is immediately contiguous to the posterior me- 
dian fissure : they are called the columns of Goll. 
The others, known as the columns of Burdach, inter- 
vene between those of Goll and the posterior nerve- 
roots. It is in these last — the columns of Burdach 
— that the sclerosis which lies at the bottom of the 
phenomena of locomotor ataxy is primarily seated, 
and to these it may be limited. 

Now it is well known that, as Hammond says,' 
"locomotor ataxia often spontaneously remits in the 
severity of its symptoms : indeed, the remission may 
at times amount to a complete intermission." This 
intermission seems sometimes to have been obtained 
to so prolonged a stage as to warrant belief in a cure 
by the internal use of nitrate of silver ; and of late 
has been frequently secured by the process of stretch- 
ing the sciatic nerves. It seems hardly conceivable 
that, spontaneously or by such measures of our art, a 
degeneration like sclerosis can alter for the better, 
however its progress may be checked. There must 
therefore be some fluctuating, functional, dynamic, 
and therefore modifiable element in the disease. Its 
primary manifestations are (I speak of the ordinary 
form) in the sensory nerves of the lower extremities, 
these being the seat of lightning-like flashes of neu- 
ralgic pain — the doiilciirs fitlgin-antcs of the French, 
and of loss of function. By the suspension of reflex 
activity thus induced the muscular coordination 

^ Diseases oj the Nervous System^ 7th ed., sub voce. 



238 CEREBRAL LOCALISATION. 

necessary for standing and walking is impaired, and 
hence the gait which gives the name "ataxy " to the 
disease. These pains and this anaesthesia are ordi- 
narily set down to compression of the fibres of the 
sensory roots, as they pass through the hardening 
columns on their way to the gray matter of the 
cord. But, if so, how could there be any variability 
in them, any long suspension or permanent removal 
of them ? Is it not far more likely that the trouble 
lies in the cells of the posterior cornua — the source 
of the energy of the sensory roots ? The columns 
of Burdach are not made up of long fibres, stretch- 
ing all the way up the cord, but of short ones, com- 
missural between one segment and another. They 
thus arise from and end in these very cells ; and as 
we have seen lateral sclerosis irritating the anterior 
cornua by a similar connexion, we have a right to 
invoke the same agency here. 

I would submit, then, that in not too advanced 
cases of locomotor ataxy, the symptoms — at any 
rate the distressing pains — are due to a dynamic 
irritation of the gray cells of the posterior cornua, 
and may be amenable to treatment. Later, the cells 
submit to the degeneration, and this extends to the 
roots, and then nothing is to be done ; but I speak 
of an earlier stage. The medicines I would urge for 
consideration here are Agaricus, Arsenicum, and 
Belladonna. 

AgaiHats developed, in the heroic Austrian prov- 
ings, a marked action on the spinal cord ; and among 
the symptoms were fugitive neuralgic pains along 



AGARICUS IN DOULEURS FULGURANTES. 239 

the spinal nerves. Dr. Dyce Brown, in a valuable 
study of the pathogenesis which appeared in the 
twentieth volume of the Monthly HomoeopatJiic Rc- 
viezu, suggested its appropriateness to the pains of 
ataxy. I have said that I could not quite follow him 
here, as the inflammatory induration which lay at 
the basis of these was beyond the range of action 
of the drug. They answered rather, I suggested, 
to those of what is called "spinal irritation." So 
far I was right ; but we have seen that the douleiirs 
fidgttrantcs are just an expression of such irritation, 
which intervenes — as it were — between them and 
the sclerosis. Dr. Brown's recommendation was 
well-founded ; and Dr. Sauer, at a late meeting of 
the Silesian Homoeopathic Society, spoke of having 
seen at least temporary benefit from the remedy. 
You will remember that the neuralgic pains of Agari- 
cus are compared to sharp ice touching the spots, or 
cold needles running through the nerves, — in this 
contrasted with those of Arsenic, where the imaginary 
needles are red-hot. 

Turning now to the drug last-named, I would say 
that the " myelitis " which has been observed from 
it is hardly that of locomotor ataxy, so that it has no 
fundamental relation to the disease. The arsenical 
paralysis, however, which is generally an epiphe- 
nomenon of poisoning by the drug, is always accom- 
panied with neuralgic pains and usually with loss of 
sensibility, at least to everything but cold. A similar 
exemption of the sense of temperature is often seen 
in the anaesthesia of ataxy, which, too, not uncom- 



240 CEREBRAL LOCALISATION. 

monly sets in with burning pains in the soles of the 
feet, and "pins and needles" or other forms of 
numbness. 

Belladonna I recommend here rather on pathologi- 
cal grounds, for I do not feel sure that the group of 
symptoms I have adduced in my PJiarniacodynaniics 
will bear much weight as parallels. Its tactile anaes- 
thesia is certainly not central, like that of the dis- 
ease, and it has never — save in one passing instance 
— caused neuralgic pain. But the grounds on which 
we nevertheless administer it as an anti-neuralgic, 
and with brilliant success, hold good here also ; and 
I should rely on it actually to preserve the gray cells 
from invasion, and so to limit and perhaps starve 
out the disease. I certainly think I once made a 
cure with it, in an incipient case, giving the ist deci- 
mal dilution. , 

2. We have, I think, another example of a dis- 
charging lesion in neuralgia. In this instance there 
is not, ordinarily, any substantive growth or change 
in the neighbourhood — any tumour or sclerosis — to 
set up the discharge : the lesion is the quasi-inflam- 
matory state of the gray nucleus of the sensory 
nerve in which the pain resides. I assume that the 
work done by the late Dr. Anstie in reference to 
neuralgia has definitively proved it to be (save of 
course when traumatic) of central origin. His small 
volume on the subject ' is worth its weight in gold : 
it is "hewn from life" and crammed full of thought. 
I differed from my old fellow-student at the time of 

^ Neuralgia and the diseases that counterfeit it. London, 1871. 



NEURALGIA. 24I 

its publication (1871) in maintaining that the nuclear 
cells and not the posterior roots were the primary 
seat of the affection, and that this was inflammatory 
rather than purely atrophic : I think that if he had 
lived till now he would have acknowledged the sound- 
ness of my criticism. But the merit of establishing 
the central seat of neuralgia was all his own ; and he 
thereby rescued the malady from being a mere ap- 
pendage to gout and rheumatism and debility, and 
gave it a definite place among the neuroses. 

Neuralgia is the manifestation of a discharging le- 
sion at the origin of a sensory nerve : it is, as another 
has called it, a nerve-storm. Sometimes its lightning 
may come in single flashes, as in the terrible tic-dou- 
loureux — the "epileptiform neuralgia" of Trousseau ; 
sometimes in a more continuous sheet of flame, as in 
the ordinary type ; sometimes, as in migraine, there 
may be a complex variety of lightning, and thunder, 
and rain, and wind. But, however it may appear, it 
is a storm — an electric outburst. Its peculiarity 
stands in its absolute localisation — its confinement 
to the nucleus of one sensory nerve on one side of the 
body. Why it should make this selective choice, we 
cannot say : what most concerns us is that drugs do 
the same thing. " Aconitine " says Schroff "pro- 
duces a peculiar feeling of drawing and pressure in 
the cheeks, the upper jaw, the forehead — in a word, 
in the parts supplied by the trigeminal nerve. This 
feeling increases little by little in intensity, and is 
transformed at first into a remittent pain which shifts 
its place, later into a continued pain of considerable 



-242 CEREBRAL LOCALISATION. 

intensity." Why this result in the trigeminus and 
not elsewhere ? The drug, in Schroff's experiments, 
was swallowed, absorbed into the blood, carried about 
in the circulation. Its molecules reached the nuclei 
of all the sensitive nerves alike : why should that of 
the fifth only undergo the morbid change which makes 
it the seat of pain ? We know not ; but this we know, 
that when the same nerve is the seat of neuralgia, of 
such kind as to indicate Aconite and its alkaloid, they 
are as effective to cure as they are to cause it. 

We have not the same evidence for the neuralgia- 
producing power of Belladonna as we have for that 
of Aconite, but its curative action is no less de- 
cided. It is by pathological analogy, rather than 
by the facial pains experienced by one of Dr. Hale's 
provers of Atropia, that we must argue its homoeo- 
pathicity. Neuralgia is a quasi-inflammatory condi- 
tion of the gray cells at thcroot of a sensory nerve. 
Belladonna sets up a similar morbid process in the 
gray matter of the cerebral hemispheres, and there- 
fore can only act as a similar here. The small dosage 
required bears out the argument ; and here also the 
trigeminus is the seat of the neuralgia in the great 
majority of the cases it benefits. 

In Aconite and Belladonna we thus have two great 
remedies for neuralgia affecting the fifth nerve, and 
they are types of two classes of analogous remedies. 
With Aconite anaesthesia accompanies the pain, with 
Belladonna hypersesthesia. It is hardly likely that an 
irritation of sensory cells so similar as in either case 
to eventuate in neuralgic pain should in one produce 



MIGRAINE. 243 

diminished, in the other increased, sensibility : it is 
more likely, therefore, that these conditions are de- 
veloped farther back and higher up than the pain, i.e. 
in the sensory centres. However this may be, Arseni- 
cum and Platina follow Aconite in having numbness 
or actual loss of sensation with their nerve-pain ; while 
Chamomilla, China, Nux vomica, and of course Hy- 
oscyamus and Stramonium, stand with Belladonna. 
Hydrocotyle has caused hyperaesthesia of the fifth 
without pain ; while Colocynth, Iris and Spigelia 
have developed neuralgic suffering without any other 
modification of sensibility. 

3. Our drug-action will become yet more cerebral 
in its localisation if from the seat of trigeminal neu- 
ralgia we pass to that of viigrainc. So much is owing 
to the French physicians for their study of this mal- 
ady that their form of the Greek Jicviicrania may well 
pass current among us, though its old English shape 
of "megrim " has much claim to adoption. It is under 
this last name that Dr. Robert Liv^eing has described 
it, in one of the best monographs with which I am 
acquainted in the whole range of medical literature.' 

Migraine, in its most common form, is known as 
"sick-headache," from two of its most constant and 
distressing features. Some persons, for similar rea- 
sons, describe it as "blind-headache." Dr. Liveing, 
however, studying the malady more Hahnemanniano^ 
has been able to construct a complete picture of its 
phenomena, seen in full only in the most typical 
cases, but so occurring by one, or two, or three as to 

' Q\\ Mc^r'uii^sick-licadachc^ and some allied disorders. London, 1S73. 



244 CEREBRAL LOCALISATION. 

leave no doubt of their coherence one with another 
and with the essential disease. '' The forms of me- 
grim " he sums up ''range from the simplest hemi- 
cranial pain, transient half-vision, or sick-giddiness, 
to cases which present a complex assemblage of phe- 
nomena and wide range of sensorial disturbance." In 
a well-developed example, the attack is ushered in by 
a peculiar disturbance of vision, and culminates in 
headache and vomiting ; but during the culmination 
there may occur numbness and tingling on one or 
other side of the body, and disorder of speech or 
thought, and at any time throughout the attack there 
may be vertigo, hyperaesthesia and hallucinations of 
the other special senses, and emotional disturbance, 
especially "a vague and unaccountable sense of fear." 
The face is generally pale and sunken ; the heart is 
slow and the pulse contracted. 

Dr. Liveing, writing in 1873, was led by the physi- 
ology of his day to find the primary seat of this 
"nerve-storm" in the optic thalamus. That of ours 
would bid us look farther ; and it is significant to 
find him noting that when disorder of speech was 
present, and numbness and tingling of one arm co- 
existed (as it very often did), it was always the right 
one. We, I say, should look to the cerebral hemi- 
spheres — in their sensory area — as the seat of the 
phenomena : we should say that the '* storm " began 
in the angular gyrus, and thence spread along the 
other sensory centres to that of speech, at last be- 
coming externalised pain with its sympathetic nau- 
sea and vomiting. 



IGNATIA. 245 

But, however this may be, our great object is to 
utilise the picture thus before us, and find medicines 
truly similar to its essential features. Let us take 
those of vision as a starting-point. The affection is 
a blind spot, most frequently central, but sometimes 
assuming the form of hemiopia ; and then almost al- 
ways lateral, very rarely superior or inferior. The 
blur is dark against a bright ground like the sky, 
but luminous on closing the eyes ; and is generally 
surrounded with zigzag coruscations, often compared 
(in shape) to the bastion-work of a fortress. It 
spreads peripherally or laterally, according as it is 
central or hemiopic, and the vision clears at the pri- 
mary spot as the obscuration widens. Its course is 
a brief one, and then comes the headache. It seems 
to be bi-lateral in all cases, and to be unconnected 
with any change (appreciable by the ophthalmoscope) 
in the retina. 

In searching for remedies with this clue, we are 
first of all led to Ignatia. Hahnemann observed, 
sixteen hours after taking a dose, '' a circle of bril- 
liant white, glittering zigzags beyond the visual 
point when looking at anything, whereby the letters 
on which the sight is directed become invisible, bm 
those at the side are more distinct;" and again he 
notes, after thirty hours, *'a zigzag and serpentine 
white glittering at the side of the visual point, soon 
after dinner." In a note, he directs attention to 
these symptoms as •* very much resembling Herz's 
so-called spurious vertigo." I cannot trace the ref- 
erence; but should think it most probable that Herz 



246 CEREBRAL LOCALISATION. 

was describing the visual phenomena of migraine, 
of which giddiness is often a potent element. Look- 
ing then to the other features of drug and disease, 
we find that the headaches caused by Ignatia were 
frequent and severe, though only once associated 
with inclination to vomit ; that difficulty of thinking 
and speaking was noted by two of Jorg's provers of 
it ; and that hyperaesthesia of the special senses and 
emotional disturbance are very characteristic of it. 
Ignatia, therefore, would be well indicated for mi- 
graine beginning with central blur and coruscations, 
and going on to severe pain with such phenom.ena as 
those just mentioned. It would be the more suitable 
if the patient were of impressionable temperament ; if 
the attacks were specially liable to be provoked by 
emotion ; if the pain assumed the form of "clavus ; " 
and if the paroxysm passed off with the emission of 
a. quantity of limpid urine. 

NiiX' vomica also has produced the visual phe- 
nomena which Hahnemann compares to the " vertigo 
spuria " of Herz ; ' so that it would seem as if the 
Strychnia common to the two were its real exciting 
cause. In its pathogenesis, however, though heroi- 
cally enough obtained, this symptom has not appeared ; 
and our wisdom will be, for the present at least, to 
use the matrix drugs. We thus moreover get two 
remedies instead of one ; for you know that Nux 
vomica and Ignatia have many points of distinction. 
The patient whom the former suits is one of different 
temperament and habits from those which call for the 

* Mat. Med. Pura, tr. by Dudgeon, S. 145. 



DIGITALIS. 247 

latter; and (remembering how it is indicated for 
brain-workers) it is noteworthy how many men of 
high intellectual power — Woolaston, Herschel, Airy, 
Lebert, Du Bois Reymond — have furnished narra- 
tives of their personal experience with migraine to Dr. 
Liveing's book. The Nux vomica migraine would, 
from its pathogenesis, have more vertigo about it 
than that of Ignatia, as much hyperaesthesia, but less 
strictly emotional excitement, — if anything of this 
kind were disturbed, it would be what we call the 
''temper." Errors in diet might well be its exciting 
cause ; but I do not think that any stress must be 
laid on vomiting in the course of it, as only once has 
the headache of Nux had this concomitant, and then 
it came on after dinner, and was sour, — very different 
from the way it occurs in migraine. 

When first the visual symptoms of migraine were 
definitely described in our day, they recalled to sev- 
eral the results obtained by Purkinje with Digitalis. 
Experimenting on himself on two occasions with the 
extract and infusion, he both times noticed much 
flickering before the eyes, and on one occasion thus 
describes his experiences: — *'The figures which the 
flickering formed were called flickering roses, because 
the form of the rose was the type : in the first ex- 
periment there were round spots in the field of 
vision, the space circumscribed by four deep oval 
lines forming four large convex indentations, and 
the waves of light and shade surrounding this exhib- 
ited the same form only less indentated. The flick- 
ering figures which appeared on the second day, and 



248 CEREBRAL LOCALISATION. 

which reached their height on the third; were sur- 
rounded by curved Hnes with five indentations, but 
more superficial, which were again surrounded by 
enlarging waves of light and shade with superficial 
indentations. During the latter days, when the flick- 
ering- decreased, there were noticed only fragments 
with the rose formation on the side, like the small 
segment of the larger and more superficially inden- 
tated circle." Now one may agree with Dr. Liveing 
that the resemblance between these *' roses" and the 
** fortification pattern" of migraine is not striking, but 
it is near enough to call attention to the drug, and on 
looking farther we find in its visual and other symp- 
toms a close parallel with the disease. In a patient 
of Baker's taking it muscae volitantes were seen be- 
fore the eyes on looking at distant objects, which, 
when the eyes were covered, became luminous. Dr. 
Brunton, when proving Digitaline, saw a large bright 
spot advancing before him ; and our own Baehr, 
under the same circumstances, had the upper half of 
his field of vision covered with a dark cloud. In him, 
moreover, a parietal headache set in in the morning, 
became worse in the afternoon, and " increased in the 
evening to a violent migraine." This was not indeed 
an unprecedented occurrence with him, but it was 
different from his ordinary attack in that then it was 
always at its worst in the morning on rising. Head- 
cxhe, moreover, often severe, is a frequent symptom 
of both Digitalis and its alkaloid : vertigo is no less 
marked from it ; and its vomiting is of cerebral ori- 
gin, slow of coming on, but, when excited, severe 



CYCLAMEN. 249 

and long lasting. Remember also the slow pulse of 
migraine, and the pale face and contracted arteries 
— the last being so often a marked feature as to lead 
Du Bois Reymond to suppose the disorder a vaso- 
motor neurosis ; and you have in forms of it fre- 
quently appearing a complete picture of the effects 
of Digitalis. 

Again, of the Austrian provers of Cyclamen, seven 
had more or less obscuration of sight, and four had 
flickering before the eyes. One of these, whose 
eyes were *'weak" and required glasses, had this 
symptom — after two doses of the drug — for six 
days in the right eye, for three weeks (though less 
severely) in the left. It began, too, with violent 
headache, which lasted unchanged for two days, di- 
minished on the third, and disappeared on the fourth. 
At one time he speaks of seeing a "luminous ball" 
before the eyes : at another, " with the eyes opened 
or closed, he seemed to see at a distance of about 
two feet a dark disk as large as a two-groschen piece, 
which seemed frequently to be pierced by brilliant 
lightnings." Vertigo and mental confusion appeared 
in the provers, and have been verified by a good 
cure. In this case they occurred in a woman at the 
climacteric ; and Dr. Eidherr had long before given 
us several cases in which the head and eye symptoms 
of the drug had co-existed with catamenial derange- 
ments such as it causes, and which had yielded to it. 
Cyclamen therefore should be useful m migraine 
occurring in such subjects and under such circum- 
stances ; and especially where its character was such 
as to lead to its being called *' blind-headache." 



250 CERKBRAL LOCALISATION. 

The last medicine I have to mention in connexion 
with this malady is the Iris versicolor. I have noth- 
ing to add to what I have written of it in the last 
edition of my Phannacodyuaniics ; but as it was the 
" blur before the eyes " preceding a sick-headache 
which first led to its employment in true migraine, 
it could not be omitted here. 

I have made no attempt, in this little study, to 
mention all the remedies applicable to migraine. I 
know the value in it of Belladonna, Calcarea, Sepia ; 
of Sanguinaria, Silica, Stannum, and of Zincum sul- 
phuricum. My aim has been simply to show how 
the finer pathological study of the present clay can 
be utilised in our practice, by associating therewith 
the knowledge we possess of the physiological action 
of drugs. If sick-headaches are at all as common 
with you as they are on our side of the water, you 
will not regret the time spent on the study of some 
less common, but not less promising, remedies for 
the aid of their victims. 

4. Finally, the whole subject of the "aura epilep- 
tica" must .be studied in its relations to drug-action. 
There is in Dr. Hammond's Diseases of the Nervous 
System a copious list of these, taken from a French 
source, and arranged with regard to their apparent 
place of origin. No better subject could be taken 
for a graduation thesis than a comparison of this list 
with the Materia Medica, and an exhibition of the 
res-ults. It might fairly tend to make our therapeu- 
tics of this obstinate malady more uniformly and 
permanently successful. 



ACONITE. 251 

II. I pass now from forms of disease to individual 
medicines, noting any relation their action may have 
to the localised functions of the cerebral cortex. 

I. Of Aconite I have said enough in relation to 
trigeminal neuralgia ; but its anaesthesia yet demands 
a word. Liegois and Hottot, as also Ringer and 
Murrell, have from their experiments come to the 
conclusion that it produces this effect by acting on 
a supra-spinal sensory centre. Hitherto this has 
been assumed to be the optic thalamus ; but now 
the tactile cortical centre may lay equal claim to 
being the seat of its influence. And what lends 
support thereto is the marked emotional excitement 
characteristic of the drug. Hahnemann's "anxious 
impatience, unappeasable restlessness, and agonised 
tossing about " will be remembered, and also the 
fear of death well known to indicate it in many dis- 
orders. Dr. Samuel Potter relates ' a partial prov- 
ing of the drug which will illustrate this. In the 
course of the well-known Milwaukee experiments, 
he was supplied with ten undistinguished vials, one 
of which contained Aconite in the 3rd cent, dilution, 
and he was to identify it (if he could) by its distinc- 
tive effects. He took frequently repeated doses from 
one of them, in a short time began to experience agi- 
tation, anxiety (wholly causeless) about an absent rela- 
tive, and finally such impressionability that the least 
thing made him start, work became impossible, and 
he had to go to bed. A similar trial of the contents 
of the other vials produced no such effects, and he 
decided (rightly) on the first as the medicated one. 

I Hahn. Monthly, Sept., 1880. 



252 CEREBRAL LOCALISATION. 

2. Belladonna plays so large a part in nervous dis- 
orders because it induces inflammatory irritation of 
the gray matter of the nervous centres. This doc- 
trine — which was only a clothing in the language 
of modern pathology of a conception universally 
current in the school of Hahnemann — has been 
supported by the researches of Dr. Harley. He 
rejects the terms ''narcotic" and "sedative" hith- 
erto in use to describe the neurotic influence of the 
drug, and substitutes " excessive stimulation of the 
nerve-centres, attended by increased oxidation " as 
accounting for the whole of the phenomena pro- 
duced by it. As the hyperaesthesia it causes in the 
sensory sphere and its jactitation in^ the motor are 
accompanied by ideational disorder in its delirium, 
there seems no doubt of its action being on the cor- 
tical centres. I need not remind you of the num- 
ber of therapeutic applications which this action 
explains. 

With Atropia, the so-called "active principle" of 
Belladonna, the inflammatory character of the symp- 
toms is much less pronounced, though it is there. 
Michea, who gave it largely to epileptics, compares 
the symptoms it produces, in cautiously-increased 
doses, in the muscles of articulation and of the ex- 
tremities, to those which occur in the early stages 
of the general paralysis of the insane ; and relates 
a case in which the diagnosis between these two 
interpretations was difficult. 

3. Cannabis Indica — the hemp of Hindustan — 
developes a peculiar resin known as haschisch, which 



CANNABIS INDICA. 253 

is eaten or smoked throughout the East (the practice 
is not, I have lately read, unknown in the West) for 
its narcotic qualities. The intoxication it induces is 
characterised chiefly bv (as I have written) " an 
intense exaltation, in which all perceptions and con- 
ceptions, all sensations and emotions, are exagger- 
ated to the utmost degree. Distances seem infinite 
and time endless ; pleasure is paradise itself, and any 
painful thought or feeling plunges at once into the 
depth of misery. Hallucinations of the senses are 
common ; and the least suggestion will set going a 
train of vivid mental illusions." That the seat of the 
drug's action is the cortex cerebri is pretty evident ; 
but is confirmed by there often being an accompany- 
ing headache, with sensation as of the brain boiling 
over, and lifting the cranial arch like the lid of a tea- 
kettle. Now you may be aware that in the disease 
just mentioned — "general paralysis of the insane" 
— one of the earliest mental symptoms is a mor- 
bid exaltation of the ideas, leading to notions and 
schemes of extravagant grandeur. The lesion seems 
to be an inflammation of the gray matter of the hem- 
ispheres and of the neighbouring membranes. It is 
not certain in which the mischief begins ; but even 
were it in the meninges, the cerebral irritation would 
be like that which causes contracture in lateral scler- 
osis, and might be greatly modified by the remedy. 
I would add that Purkinje experienced a similar exag- 
geration of the perceptions of time and distance from 
Nnx vioschata, and that the neurotic effects of this 
drug — which have as yet hardly been utilised — 



254 CEREBRAL LOCALISATION. 

correspond well to a somewhat more advanced stage 
of the malady. 

4. I did not mention Coccidus while speaking of 
migraine, because it does not cause the visual symp- 
tom of the disorder, for which, nevertheless, it is a 
leading remedy. The fact is, it covers its motorial 
side alone, Cocculus having apparently no action on 
the sensory tract of the cranio-spinal axis. It is 
therefore indicated when migraine occurs under the 
form of "sick-giddiness " only, and when vertigo and 
vomiting (often with slow pulse) form the leading 
features of the more fully-developed attack. I have 
given in my PJiannacodynainics a beautiful cure of 
Dr. Black's illustrating its action, which would ap- 
pear to be exerted mainly on the cerebellum and its 
associated centres, as shewn by the character of the 
convulsions excited by its alkaloid picrotoxine. These 
are semi-circular and backward movements, and roll- 
ings over on the axis of the body, such as have been 
observed from experimental injury to the crura cere- 
belli (not ''cerebri," as misprinted in my book), and 
from electrisation of the cerebellum itself.' 

5. This, as well as alphabetical order, leads me 
here to speak of the influence of ConiiLm over the 
optical part of the mechanism of equilibration. That 
the visual impressions proper for this function may 
be conveyed to the cerebellum, it is necessary that 
the axis of vision as preserved by the ocular muscles 
should be correct. Conium paralyses these, and 
hence, the giddiness on every fresh adjustment of 

^ Ferrier, op, cit., p. 98. 



CONIUM. 255 

focus observed by Dr. Harley, and occasionally such 
symptoms as those experienced by Dr. Edward Cur- 
tis. After taking half a drachm of Squibb's fluid 
extract, he could not walk across the room zvith his 
eyi's open without giddiness, reeling, and feeling as 
if. he would vomit ; but directly he closed his eyes 
all the symptoms passed off, and he could move 
safely.' This explains the benefit obtained in threat- 
ened sea-sickness from shutting the eyes, or at any 
rate not looking at the swaying boat and waves. In 
this connexion let me remind you that Qitiniue and 
Salicylic acid exercise a similar influence as regards 
the part played in equilibration by the semi-circular 
canals of the ear ; and that here the pathogenetic 
effect has been turned to good account, both reme- 
dies having been used with advantage in Meniere's 
disease in its curable stage. 

6. The emotional erethism caused by CJiamomilla 
and Coffca (with some other vegetable medicines) on 
the one side, and by lodiinn and MerciLrius on the 
other, seems referable to action on the sensory region 
of the cortex, for in all it coexists with great sensi- 
tiveness to pain. With the former it is functional 
only, but with the latter (especially with Mercury) 
it may be the beginning of organic disease, i.e. of 
softening. It is worthy of note that insomnia charac- 
terises all. Sleep, whatever be its cause, is certainly 
a function of the brain proper : only consciousness 
can become unconscious, as only life can die. The 
mental condition induced by Iodine and Mercury is 

* Allen, sub voce. 



256 CEREBRAL LOCALISATION. 

little known, and should be studied : it may often 
guide us to these profoundly acting drugs at the 
commencement of serious brain disease, and arrest 
it ere it has gone into substantive change. 

7. And now a few words on Santonine. Every- 
one knows the xanthopsia — the yellow vision pro- 
duced by this drug, and you are probably aware that 
in higher degrees of its influence the colouring is 
violet. These, however, are visual illusions^ which 
disappear with the objects on closing the eyes, and 
are due to alterations in the pressure of blood at 
some part of the optic tracts. But Santonine pro- 
duces also visual Jiallucinations, seen just as well with 
the eyes shut, and independent alike in time, in fre- 
quency of occurrence, and in degree, of the illusions. 
Dr. Edmund Rose, of Berlin, who has studied these 
phenomena very fully, shews that they must be of 
cerebral origin ; and points in confirmation to con- 
comitant hallucinations of other senses — touch, 
sight, taste, not hearing, with the evidently sympa- 
thetic vomiting, and the commencement of the con- 
vulsions (when they occur in poisoning by it) in the 
muscles supplied by the cranial nerves. A fellow- 
professor has spoken of experiencing some mental 
incoherence from it ; and Dr. Farquharson, of Lon- 
don, who tried it on himself, writes — '* The best- 
marked symptom was a feeling of profound and 
most unusual depression, accompanied by so much 
irresolution and want of confidence in my own pow- 
ers as to render me quite unfit for work of any kind. 
This invariably followed even a single five-grain dose, 



SANTONINE. 25/ 

and, beginning with clulness and heaviness, ran on into 
very much the sort of melanchoUa which I imagine 
jaundice must produce." 

This marked action on the brain ought to be util- 
ised.^ That it can be appears from some of the eye 
cases treated by Drs. Ogston and Dyce Brown, among 
which cerebral amblyopia and paralysis of the motor 
ocuK were greatly benefited, and concomitant head- 
aches removed. It evidently acts on the sensory 
portion of the cortex cerebri. 

As this will be the last time we shall study individ- 
ual drugs together, I will ask your attention to one 
feature in our mode of proceeding which I think wor- 
thy of notice. It has been very common of late to 
hear it said that drugs "have " such and such symp- 
toms, or that we find these ** under them;" without 
any heed being taken as to how the drugs got the 
symptoms, or how the symptoms came under the 
drugs. Now this practice may be convenient, for 
brevity's sake ; — but I venture to object to it as peril- 
ous. Had we a pure and sound Materia Medica, it 
might be indulged in ; but in our present confusion 
of genuine and imaginary, of pathogenetic and clini- 
cal, of real experience and wholly supposititious infer- 
ences, it is most unsafe. Our only security lies in 
ascertaining the source of any asserted drug-action 

^ Dr. Heber Smith, who was present at this lecture, afterwards informed 
me that he had obtained striking and peimanent benefit from Santonine in a 
case of recurring occipital headaches of much severity, accompanied by- 
visual hallucinations as of red fire-balls moving about. He gave the 2X 
trituration. 



258 CEREBRAL LOCALISATION. 

we wish to utilise, and — if we are writing for or 
teaching others — in stating it. To do so may often 
involve periphrasis ; but this is one of the cases in 
which the shortest cut is the longest way. To make 
sure of our ground before we stand on it is the 
wisest course to follow when we are threading a 
morass. 

And so we are brought back to the state of our 
Materia Medica, and the need of reform therein, 
which was broached in our fourth lecture. In the 
next and concluding one I purpose taking up the sub- 
ject anew, and shewing more in detail what is our 
present position, and what our prospects and means 
of remedy. 



XII. 

THE FUTURE OF PHARMACODYiNAMICS. 

As an introduction to the third volume of his Ma- 
tcria 3fcdica P?(m {i^l ed. 1816, 2nd ed. 1825), Hahne- 
mann prefixed " An examination of the sources of the 
common Materia Medica." In this scathmg criticism 
he passes in review the current methods of arriving 
at the knowledge of the value of medicines, and ex- 
poses their utter inefficiency. He discusses the as- 
cription of general therapeutic virtues, as when drugs 
are styled resolvent, tonic, and so forth ; the infer- 
ence from sensible properties, as those of the bitters 
and aromatics, or from chemical qualities ; and the 
2iS7is in morbis, shewing conclusions from this source 
to be vitiated by polypharmacy and lack of individ- 
ualisation. Such sources, he concluded, were turbid, 
and a Materia Medica drawn from them was unwor- 
thy of confidence. It was full of error and falsehood ; 
and " error in the most serious and important of all 
earthly vocations, the healing of the sick, must have 
the most grievous consequences;" while "falsehood 
here is the greatest of crimes, being nothing less 
than high treason against humanity." 

259 



26o THE FUTURE OF PHARMACODYNAMICS. 

These were strong words, but they *nly expressed 
what Hahnemann sincerely felt. Nor had he con- 
fined himself to feeling, or to shewing the worthless- 
ness of the existing material He had learned and 
taught the more excellent way of arriving at the 
knowledge of medicines, viz. : by ascertaining their 
action on the healthy body ; and he had made some 
progress in such ascertainment, and in communicat- 
ing its results to the profession. Before he died, he 
had published ten volumes containing pathogeneses 
of drugs — six of the Materia Medica Para, four of 
the Chronic Diseases. The impetus he gave to the 
work of proving drugs has continued to this day 
among his own disciples, and has spread even among 
the followers of traditional medicine, so that his ten 
small octavos, with their ninety three medicines, have 
expanded into the ten large ones of Allen, with their 
seven hundred. Our quantity of material is unques- 
tionable, — but it is necessary that we keep strict 
watch over its quality : ever and anon, if we would 
follow Hahnemann, we must institute an *' examina- 
tion into the sources of the common Materia Medica." 

The master's way of proceeding, in his day, was to 
plunge at once into criticism. In ours, we shall do 
more wisely to begin by laying down principles, 
which shall serve us hereafter as standards for judg- 
ment. Assuming, then, that the best way of learn- 
ing the action of medicines is the investigation of 
their effects in health, we have two classes of organ- 
isms on which these can be ascertained — the lower 
animals, and man himself. 



EXPERIMENTS ON ANIMALS. 261 

I. There was a time when the corpus vile of brutes 
was thought the only ground on which fict cxpcrimeji- 
tuui ; and even now it plays by far the largest part 
in the pharmacological research of the profession 
at large. If this were sound practice, Hahnemann 
would be somewhat discredited ; for he, recognising 
that it was available, deliberately rejected it. But 
have his arguments against its adequacy ever been 
answered ? The first is that the effects of drugs are 
different on them and on us, and different as between 
themselves. " A pig can swallow a large quantity of 
nux vomica without injury, and yet men have been 
killed with fifteen grains A dog bore an ounce of 
the fresh leaves, flowers and seeds of monkshood : 
what man would not have died of such a dose ? 
Horses eat it, when dried, without injury. Yew 
leaves, though so fatal to man, fatten some of our 
domestic animals. . . . The stomach of a wolf poi- 
soned by monkshood was found inflamed, but not 
that of a large and a small cat, poisoned by the same 
substance." Thus Hahnemann, and similar facts have 
come to light in later times, among which I may 
mention the impunity with which the rabbit may be 
fed for days upon belladonna leaves. The argument 
from them has been urged afresh in the forty-first 
volume of the British Journal of HoniccopatJiy, and 
shewn to be borne out by the contradictory results 
of recent pharmacological research on animals. 

The second objection is yet more destructive : it 
is that we cannot obtain subjective symptoms from 
dumb creatures, and we have seen how important 



262 THE FUTURE OF PHARMACODYNAMICS. 

these are in Ihe knowledge — for curative purposes 
— of disease, and therefore also of drugs. We may 
point this objection by the instance of Aconite. In 
experiments on animals, loss of sensibility of the 
surface is often noted : hence the drug is supposed 
to be an anaesthetic, and suited for employment in 
neuralgia and other simple pains, for which it must be 
given in physiological doses, or — when the affected 
parts can be reached — applied locally. But con- 
sult human poisonings, or, still better, provings, and 
another tale is told. While the surface may be in- 
sensible to external impressions, it is not so to the 
patient's own consciousness It is an ancBstJiesia do- 
lorosa horn which he is suffering, and one which — as 
we have seen in Schroff's provers — may develope 
into actual neuralgic pain, to which therefore Aconite 
is truly homoeopathic, and which it will cure by inter- 
nal administration and in non perturbing dosage. 

These objections are surely fatal to any exclusive 
or even predominant reliance on experiments upon 
animals, for ascertaining the properties of drugs. 
But on the other hand they have a place, which 
Hahnemann was ready to acknowledge (thirty years 
before Majendie began their systematic institution), 
and which the provings of his school, when thorough, 
have always given them. Besides the induction of 
the more violent effects of the drugs, and the ascer- 
tainment at will — by autopsies — of the lesions they 
set up, we can learn upon these subjects the result of 
their long-continued employment in doses sufficient 
to change without killing. In this way Wegner has 



roisoNiNGS. 263 

discovered the power of Phosphorus to induce a plas- 
tic irritation of periosteum and of the interstitial tis- 
sue of the stomach and liver, and Eugene Curie has 
shewn Bryonia capable of exciting pseudo-membra- 
nous deposit and Drosera that of tubercle. Again, 
experiments on animals lend themselves to analysis 
and interpretation. Dr. Lauder Brunton has well 
shewn how in this way the rapid circulation of Atro- 
pia has been proved to be due to paresis of the termi- 
nal extremities of the v^agi in the heart ; and the 
opposite effect of Digitalis has been demonstrated 
to result from stimulation of the same inhibitory 
fibres at their origin. It is not always that here le 
jeu vaiit la cJiandelle — that we take much by our 
knowledge ; but, assuming it to be worth having, it 
is certainly from experiments on animals that we 
must obtain it. 

IL Such experiments, then, being of subsidiary 
value only, we turn to the action of drugs on the 
human body as the main source of our knowledge of 
them. This knowledge must be gained in pharma- 
cology, as in all other sciences, by observation and 
by experiment, 

I. Observation, in the present instance, has for its 
field poisoning of healthy and ov^r-dosing of sick per- 
sons ; and each of these sub-divisions requires sepa- 
rate discussion. 

a. Poisoning is obviously limited to the compara- 
tively small class of drugs sufficiently virulent to 
produce such effects. Here, however, it is of great 
value. It supplies the more violent disturbances and 



264 THE FUTURE OF PHARMACODYNAMICS. 

the post vioriiDi changes induced by medicinal sub- 
stances better (because more surely) than experi- 
ments on animals can do : it aids us greatly in arriv- 
ing at the lesions they can produce, and in obtaining 
correspondence of seat between drug-action and dis- 
ease. Records of poisonings and works on toxicol- 
ogy have therefore been always largely employed, 
from Hahnemann downwards, in the construction of 
our pathogeneses ; and nothing can be said against 
this source of knowledge save that it is, as it were, 
illegitimate. Poisonings are the product of crime or 
of carelessness, and in the progress of society should 
become more and more rare; so that we may not 
lean too confidently upon them as materials of future 
information. 

b. Over-dosing may also be said to be a remediable 
error ; but as long as traditional medicine is prac- 
tised it will be liable to occur again and again, as it 
has occurred in the past. The object of both anti- 
pathic and alloeopathic medication being to induce the 
physiological actions of drugs, these are continually 
being observed ; while even in " alterative " treatment 
the ponderable doses deemed necessary, and the oc- 
casionally quick susceptibilities of patients, determine 
the eliciting of collateral effects. The older treatises 
on Materia Medica draw largely on such observations, 
partly for knowledge as to pathogenetic action, and 
partly for warning against excessive dosage. The 
obvious weakness of effects so obtained is the uncer- 
tainty which belongs to them, owing to their exhib- 
iter being already the subject of disease. Of course, 



PROVJNGS. 265 

if this be of a definite and limited character, and con- 
sisting with fair general health ; and if all symptoms 
conceivably resultmg from it, or occupying the same 
seat, are excluded, and likewise all phenomena pre- 
viously observed in or by the patient during his ill- 
ness, — then pathogenetic effects may be taken from 
the sick almost as safely as from healthy persons. 
Some of our best records of the symptoms produced 
by atropia, as those of Grandi, Michea, and Lussana, 
have been in this manner obtained ; and without it 
we should know next to nothing of the physiological 
action of the bromide and iodide of potassium and of 
salicylic acid. 

2. We come now to experiment, which here, as in 
other departments of research, should be our princi- 
pal resource. Very little use, however, had been 
made of it up to the time of Hahnemann. Haller's 
insight had perceived its need ; and he had written 
— "It is upon the healthy body first that the medi- 
cine, free from any foreign admixture, is to be tested ; 
its taste and odour to be ascertained, and then, small 
doses being swallowed, their effects to be fully noted, 
how the pulse behaves, how the temperature, how 
the breathing, how the excretions." But his words 
had fallen on barren ground ; for there is no trace of 
any connexion between them and the few provings 
which were extant at the end pf the last century. 
Stoerck (i 750-1 760) had swallowed a few doses of ac- 
onite, conium, and colchicum, -— merely, however, to 
ascertain whether and how far they could be admin- 
istered with impunity. Alexander (1768) had tested 



266 THE FUTURE OF PHARMACODYNAMICS. 

on his own person castor, saffron, nitre and camphor; 
but here again as much to try whether these sub- 
stances had any activity at all (which question in the 
case of the first two he was led to answer in the neg- 
ative) as to discover their ''doses and effects" if 
really operative. Grimm (1767), Crumpe (1793) and 
Bard (1755) had made some experiments with opium, 
Coste and Willemet (1778) some with asarum, and 
Wasserberg one with belladonna. These were the 
only forerunners of Hahnemann ; and how few and 
feeble were their efforts ! He, on the other hand, 
once persuaded of the necessity for therapeutics of 
drug-provings on the healthy human body, proceeded 
to institute them on the most extensive scale, and to 
publish his results. 

Before we go on to estimate the w^orth of these, let 
us consider how a proving should be conducted. It 
should secure healthy persons as its subjects, or such 
as, from the limited seat and known symptoms of any 
malady they might have, are practically so. They 
should either have some medical knowledge them- 
selves, or should be interrogated by a superintending 
physician. They should be free from the action of 
any disturbing causes, mental or bodily. Since acute 
disease is generally induced by single potent causes 
— a chill, a shock, a morbid poison, &c., and chronic 
disease by a succession of slighter ones, the medicine 
to be tested should be taken both in single full doses, 
and at another time in small ones repeated more or 
less frequently until some effect is obtained. To 
avoid the influence of expectant attention, the 



THE FRAC^fENTA DE VIRIBUS 267 



prover should not know what dm?; he is taking. 
Finally, that mere natural oscillations in health 
should not be set down to the medicines, the prover 
should note any symptoms observed in himself for 
some days previous to beginning his experiments. 
This last refinement must not be expected of Hahne- 
mann, however much its absence may vitiate his re- 
sults. It was not till 1871 that Dr Hamilton shewed 
us ' how many slight deviations from the norm will 
occur in a man presumably healthy who records his 
own daily feelings and donigs ; nor till 1877 that your 
own Professor C Wesselhoeft exhibited the effect of 
combining herewith the influence of expectant atten- 
tion.^ Putting this aside for the moment, let us en- 
quire how far the provmgs published by Hahnemann 
come up to the standard we have erected. Parts of 
what I now have to say have already seen the light 
in divers places ; but I think it well to bring the facts 
and considerations relating to the subject in one focus 
to-day, that, knowing what pharmacodynamics has 
for you 111 the present, you may follow me in the at- 
tempt to state Its needs for the future. 

I. Hahnemann's first publication (1805) was his 
Fraguicnta dc viribus nicdicanicntormn positivis. It 
was written, as its name implies, in Latin, and con- 
tained pathogeneses of twenty-seven drugs. As its 
contents were subsequently incorporated with the 
larger works — mainly with the Materia Mcdica Pura, 
I will only say of them that the symptoms referable 

' Brit. Journ oj Hoiii., xxix.. 565. 
2 Trans. Amer. Inst, of Horn., 1S77. 



268 THE FUTURE OF PHARMACODYNAMICS. 

to provings appear to have been the resuhs of single 
full doses of the several drugs, and that Hahnemann 
speaks of them as having been noted *' in a careful 
and sceptical manner." 

2. The Rcine Arznchnittcllchre, better known by its 
Latin name of JSIatcria Mcdica Piira, began to be 
issued, in successive volumes, in 1811, and the first 
edition was completed in 1821. In 1822 a "second, 
augmented edition" began to appear, and ran on in 
like manner until 1827. In 1830 and 1833 respec- 
tively the first and second volumes entered a third 
edition, which, however, went no farther. Our trans- 
lation of the work thus contains the medicines of the 
first two volumes in their third, of the other four in 
their second revision. The dates of these are im- 
portant to bear m mind, as they correspond to epochs 
of Hahnemann's life, and afford a clue to the manner 
in which the symptom lists were obtained. 

The first edition of the Materia Mcdica Pura con 
tained sixty-one medicines, besides the magnet (of 
which the less said the better, though the numerous 
citations from authors ' shew that Hahnemann was 
not alone in supposing it to be capable of disordering 
the healthy functions). In the second edition, three 
more — Ambra, Carbo animalis and vegetabilis — 
were added to the sixth volume (1827) ; and, m the 
third, Causticum was omitted from the second vol- 
ume. The total is thus sixty three. The patho- 
geneses are made up of three elements, each of which 
must be examined separately. 

* In the second edition, 195 (out of 86 ij. 



Hahnemann's symptoms. 269 

a. The first are the symptoms vouched for by 
Hahnemann himself, and which, until the third edi- 
tion, occupied a separate list, — the symptoms of fel- 
low-provers and the extracts from medical literature 
appearing together in a second as '* Observations of 
Others." Those of the Fragmcnta dc viribiLS were 
elicited, Hahnemann tells us, by experiments made on 
his own person and on that of others whom he knew 
to be perfectly healthy — probably members of his 
family. We may reasonably so account of the 
symptoms furnished by him to the first edition of 
the Materia -Medica Pitra ; and, as they had probably 
been obtained during the six years intervening be- 
tween the two publications, we may suppose these 
likewise to be the effects of single full doses. 

The same cannot be said, however, of the addi- 
tions made by him to the second and third editions. 
Even for those of the earlier volumes, it is hardly 
likely that he had instituted fresh experiments with 
the same drugs on himself or his family ; and those 
made on his disciples — including his son Friedrich 
— are separately given. There is reason to think, 
therefore, that he had already begun his undoubted 
later practice of noting fresh symptoms appearing 
in patients after drugs had been given them, and 
ascribing these to the medicines they were taking. 
During this period, i.e. from 181 1 onwards, he was 
using attenuated remedies pretty freely, so that 
many of the symptoms thus obtained must have 
appeared while these were being administered. 

We shall see immediately what grave objections 



270 THE FUTURE OF PHARMACODYNAMICS. 

lie against this mode of eliciting the supposed patho- 
genetic effects of drugs. Its large use by Hahne- 
mann vitiates the symptoms supplied by him even 
to the Materia Mcdica Piira. It would be a boon 
if any one would have the patience to go through 
our present English version with the first edition of 
the original, and mark all symptoms belonging to it, 
which then we might count on as genuine. Until 
any have been so identified, we cannot be sure of 
their not belonging to a different category. 

b. In the volumes from the second (1816) onwards, 
Hahnemann was able to follow up his own symptoms 
with a number obtained by fellow provers, of whom 
thirty-seven in all co-operated with him during the 
progress of the work. They were disciples of his 
who had gathered round him during his brilliant 
career at Leipsic, and whom he had enlisted m the 
task of proving. From his own account he appears 
to have taken every precaution that they, and any 
others on whom they might experiment, should be 
in good health and under normal circumstances ; and 
that the influence of any disturbing causes should 
be eliminated by omitting, or at least bracketing as 
dubious, symptoms then occurring. Dr. Hering 
also tells us how carefully he examined his provers 
on receiving their day-books, so as to ensure fulness 
and accuracy. As regards the manner of proceed- 
ing, it would seem that insoluble substances were 
proved in the first trituration (centesimal of course), 
and vegetable drugs in the mother-tincture — re- 
peated small doses being taken until some effect was 



CITATIONS FROM AUTHORS. 271 

produced. An exception must be made for the three 
new medicines of the second edition of the sixth 
vohime — Ambra, Carbo animaUs and vegetabihs, — ■ 
where, certainly in the case of the ^'ast, and probably 
in that of the first two, the third trituration was 
employed. 

I think, then, that — all deductions being made 
for physiological oscillations and the influence of 
expectant attention — the symptoms of Hahnemann's 
fellow-provers in the Materia Mcdica Piira may be 
accepted as substantially genuine and trustworthy. 

c. We come now to symptoms taken from authors, 
which are absent from only thirteen of the pathogene- 
ses, and with which the remainder are so abundantly 
supplied as to raise the total to over four thousand, 
about one-twelfth of the whole. These symptoms 
are either general statements of writers on Materia 
Medica, or observations of poisoning or over-dosing. 
The first may stand for what they are worth ; but, 
considering the uncritical character of most of their 
enunciators, they need confirmation before having 
much weight leant on them. Observations of poi- 
soning are always valuable, provided the causa is vera, 
the subject healthy, and the influence of the anti- 
dotal treatment allowed for. I make the first two 
stipulations, because Hahnemann has included in his 
pathogenesis of Cannabis sativa a number of symp- 
toms observed in workers in hemp, including such 
trifles as cataract, enlarged liver, ascites, cystople- 
gia, incurvation of the spine, pneumonia, and mania. 
Neither by the reporters, nor (I imagine) by any 



2/2 THE FUTURE OF PHARMACODYNAMICS. 

Other person in the world, were or would these per- 
fectly natural disorders be ascribed to the very mild 
noxa of the hemp which surrounded their subjects. 

I am sorry to say that this is too faithful a speci- 
men of the manner in which Hahnemann has gone 
to work with medical literature. He takes a case 
or series of cases treated by a drug, and sets down 
as many as he pleases of the symptoms noted as 
occurring in the patient from day to day as effects 
of the same, without regard to the disease which is 
being treated or other causes which may hav^e been 
operative. In my Soinxes of tJie HomceopatJdc Ma- 
teria Medica, the substance of which is reproduced 
in the second and third lectures of the fourth edition 
of my P Jiarmacodynamics^ I have exhibited many 
instances of this mode of proceeding, and have 
shewn its disastrous results. I cannot reproduce 
them here : I can only give the gross results of an 
investigation in which I have consulted ev^ery author 
and examined every symptom quoted by Hahne- 
mann, both in the Materia Medica Piira and in the 
CJironic Diseases, so far as those have been accessible 
to me and these traceable. I regret to have to say 
that many hundreds of these citations, consisting of 
symptoms observed in patients, have no more right to 
be ascribed to the drugs they were taking than had 
the diseases I have just enumerated to be set down 
to the hemp in which their subjects were working. 

I hav^e shewn (in the same place) by extracts from 
his writing's that Hahnemann was not insensible to 
the risk he was runnins: in drawino: from such im- 



THE CHRONIC DISEASES. 2/3 

pure sources ; but that the exaggerated notions he 
entertained of the potency of drugs led him to set 
down all the sufferings, accidents, and changes of 
health occurring in patients as solely derived from 
the medicines they were taking. He himself, in- 
deed, describes such symptoms as " corroborative ** 
only ; but they have taken their place in his patho- 
geneses side by side with the others, and thence have 
been transferred to manuals and repertories with 
their distinguishing references omitted. Nor is it of 
much avail to publish corrections, as has been done 
in Allen's Encyclopcedia and in Dudgeon's transla- 
tion of the Materia Medica Pnra. " Rage during 
the menses " is still quoted as an effect of Aconite, 
though it has been shewn that the subject was a 
maniac; and so of a host of equally untrustworthy 
symptoms. 

3. Hahnemann's third and last collection of patho- 
geneses constitutes (with the introductory essay) the 
work entitled Die eJironiseJien KrankJieiten, "Chronic 
Diseases." The first edition consisted of three vol- 
umes published in 1828, and a fourth in 1830. The 
second and third of these contained fifteen medicines, 
all new ; the fourth, with two new ones, presented 
enlarged symptom-lists of five which had already ap- 
peared in the Materia JMedica Piira. The second 
edition appeared in successive parts between 1835 and 
1839. Besides the twenty-two medicines of the first 
edition it contains twenty-five others. Twelve of 
these had already appeared in the Mateiia Mediea 
Pitra, and the rest (with few exceptions) in the Frag- 



274 THE FUTURE OF PHARMACODYNAMICS. 

vicnta or in Stapf's journal, the ArcJdv ; but nearly all 
have laEge additions. For all Hahnemann acknowl- 
edges contributions from fellow-observers, and for 
many cites symptoms from the extant literature of 
his day. 

Of these last I have nothing to say different fiom 
what has come before us relative to them when oc- 
curring in the former work. I have only to speak, 
then, of Hahnemann's own contributions, and of those 
of his associates. 

a. The pathogeneses contained in the two volumes 
issued in 1828 appear without a word of explanation 
as to how the symptoms were obtained, and the 
names of no fellow-observers are mentioned. The 
absence of any co-operation on the part of others is 
further to be inferred from what we are told of the 
first announcement of the work. After six years of 
solitude at Coethen (to which he had been driven from 
Leipsic in 1821) Hahnemann "summoned thither his 
two oldest and most esteemed disciples, Drs. Stapf 
and Gross, and communicated to them his theory of 
the origin of chronic diseases, and his discovery of a 
completely new series of medicaments for their t7/;r." 
So writes Dr. Dudgeon. That he should now first 
reveal these new remedies, and in the following year 
should publish copious lists of their pathogenetic 
effects, confirms the inference to be drawn from hi^ 
position and from his silence as to fellow-observers. 
He was himself between seventy and eighty years 
old, and it is hardly likely that he did anything in 
the way of proving upon his own person, as indeed 



HAHNEMANN S CONTRIBUTIONS. 275 

he makes no mention of having done. We are com- 
pelled to the conclusion that he drew these symptoms 
from the sufferers from chronic disease who flocked 
to -his retreat to avail themselves of his treatment. 

The prefatory notices to the several medicines 
still further substantiate this view, and throw some 
light on the doses with which the symptoms were ob- 
tained. He recommends almost all the medicines to 
be given in the dilutions from the i8th to the 30th ; 
and repeatedly makes some such remark as this — 
*' For some time past I have given the 6th, 9th, and 
1 2th potencies, but found their effects too violent." 
I infer, therefore, that it is these "violent effects" of 
the dilutions from the sixth to the twelfth, experi- 
enced by the sufferers from chronic disease who took 
them, which make up the unexplained pathogeneses 
of 1828. Of those of 1830-1839, Hahnemann's con- 
tributions — often large — must be explained in the 
same manner, save that the 30th dilution must have 
been their most frequent (supposed) eliciter, as in 
1829 Hahnemann had laid this down as the one form 
in which all remedies should be given. I must except, 
however, from this description such symptoms as be- 
long to previous provings in which he had taken part, 
as those of Cuprum and Mezereum from the Frag- 
incnta, and those of Anacardium and Platina from the 
ArcJiiv. 

It thus appears that (with few exceptions) Hahne- 
mann's contributions to the pathogeneses of the 
CJirouic Diseases are (supposed) effects of attenua- 
tions from the sixth to the thirtieth, observed in sick 



276 THE FUTURE OF PHARMACODYNAMICS. 

persons taking them as medicines. As to their ori. 
gin from infinitesimal quantities I have nothing to 
say at present. The subject is a large and difficult 
one, and demands a lecture to itself, which I have 
given to it m my book. This only must be affirmed, 
that there can here be no idea of over-dosing in the 
ordmary sense of the word. The real question is — 
can we trust Hahnemann's discrimination in the mat- 
ter of symptoms taken from the sick ? Our studies 
among his citations from authors supply the answer. 
We saw him there, as it were, at work among pa- 
tients ; and found that his eager desire for symptoms, 
and his over-estimation of the activity of drugs, had 
led him in numerous instances to put down as path- 
ogenetic effects phenomena which were obviously 
those of the disease or of occasional causes. We can 
have no confidence, but rather the reverse, that he 
has not followed the same course in his observations 
on his own patients Hence (in the first edition of 
the Chronic Diseases) the thousand symptoms of Cal- 
carea and Phosphorus and the twelve hundred of 
Sepia — all derived from sick persons during (prob- 
ably) the six or seven years of the Coethen period. 
The re proving of the last medicine by the American 
Institute, in which thirty healthy persons took part, 
only yielded 517 symptoms as its result. Hence, 
too, the increase of the symptom-list of Sulphur, from 
1,041 in 1830 to 1,969 in 1839. The additions are 
nearly all Hahnemann's, who certainly was not a 
prover at this time, but was (on the ground of the 
psora-theory) increasingly a sulphur giver to the sick. 



HAHNEMANN S ASSOCIATES. 2'J'J 

b. Hahnemann's associates in supplying- t.he path- 
ogeneses of the second edition of the Chronic Diseases 
were of various kinds. Some of them were pubhshed 
books, as the Arznciviittcllchrc of Hartlaub and Trinks 
and the Matcrialicn of Jorg. Some were the men 
whose work with him in earher and better times he 
reproduced in these pages But over and above 
these, he acknowledges as fellow-provers for the pres- 
ent work a band of later disciples; and these, it must 
be believed, made all their experiments with globules 
of the 30th dilution. In the edition of the Organon 
published in 1833 Hahnemann recommends all prov- 
ings to be made therewith, as yielding the best re- 
sults ; and from the preface to Natrum muriaticum 
in the Chronic Diseases volume of 1830 we find that, 
in the case of the three persons who contributed 
symptoms to it, the practice had already been begun. 
We may fairly extend the inference to all provings 
subsequently made. 

Here, too, I have no desire to prejudge the ques- 
tion of the pathogenetic activity of infinitesimals, 
though certainly any reasonable faith in it is put to 
a severe strain. I only wish that you should know 
with what you have to deal. I could further wish 
that the development of their symptoms herewith was 
the worst thing I had to say of Hahnemann's new 
associates. But I fear that the demoralising influ- 
ence of his practice among the sick had begun to 
lead them also in the same direction. One offender 
here there certainly was — one in many other respects 
entitled to sincere honour, Constantine Hering. His 



2/8 THE FUTURE OF PHARMACODYNAMICS. 

first and (T think) only appearance as one of Hahne- 
mann's associates is in the pathogenesis of Arsenicum, 
given as a sort of appendix to the fifth part of the 
second edition of the Chronic Diseases ; and all his 
symptoms were avowedly obtained from leprous pa- 
tients taking the drug, of course in the 30th dilution. 
Read them over, as translated from the original in 
the ArcJiiv in the nineteenth volume of the BritisJi 
Journal of HovKJCopathy (p. 633), and I am sure you 
will agree that they are to be rejected. Wahle is 
another of the present band of disciples who seems, 
from internal evidence, to have sinned in this way, 
and his symptoms must be received with a good deal 
of suspicion. 

The view of the pathogeneses of the Chronic Dis- 
eases now put before you was published some ten 
years ago, and has re-appeared in more than one form 
since. Until quite lately it has received no chal- 
lenge. . Two champions have now advanced to do 
battle on behalf of the work, — Dr. Sircar, of India, 
and Dr Pope, of England. The former, in a recent 
number of his excellent Calcutta yournal of Medi- 
cine, objects that Hahnemann expressly states that 
he learnt the "antipsoric " character of certain 
substances by experimentation on the healthy. This 
is so; but the statement in question is taken from 
the introduction to the second edition, which in- 
cludes — as I have shewn — many medicines of the 
past and the results of many fresh provings. My 
contention that the symptoms were taken from the 
sick applies only to Hahnemann's personal and fresh 



DR. POPE S VINDICATION. 279 

contributions to the pathogeneses, which neverthe- 
less make up their great bulk. Dr. Pope,' while 
allowing his inability to traverse my allegations, re- 
fuses my conclusions on two grounds, — the viola- 
tion of his own canons of which Hahnemann would 
have been guilty had he acted as I describe, and the 
verification of the symptoms of the work by clinical 
experience. To the first I reply, that inconsistency 
is too common in human nature for its improbability 
to outweigh the evidence I have brought forward. 
To the second, that (i) I have already admitted that 
the second edition, which is that in our hands, con- 
tains many symptoms perfectly trustworthy, and (2) 
that too much stress must not be laid on clinical ver- 
ification, here and there, of such extensive symptom- 
lists. Since those of each polychrest contain nearly 
every possible variation from health, any success ob- 
tained with these drugs would find reflection at some 
point of their course. Again, had the curative ap- 
plication of these remedies been drawn solely from 
their pathogeneses, it ought to be somewhat commen- 
surate with the range of these ; whereas Natrum mu- 
riaticum, with its 1,345 symptoms, has become an 
important remedy, while Natrum carbonicum, with its 
1,080, IS almost unused, and many similar anomalies 
might be presented. The fact is, our use of these 
medicines is largely traditional and empirical (the 
application, for instance, of Natrum muriaticum to in- 
termittents), and has little relation to their catalogues 
of symptoms. 

* Monthly Horn. Renew ^ May, 1SS4. 



280 THE FUTURE OF PHARMACODYxN^AMICS. 

1 have spent much time over these pathogeneses 
of Hahnemann's, partly from the large space and pre- 
rogative position they occupy in our Materia Medica, 
and partly from the typical picture they present of 
the rest of its material. Much of this is thoroughly 
good, — as good as the provings and poisonings of 
the Fragmcnta and the first edition of the Materia 
Medica Pura ; and, in its original form, is far better 
presented. In this description I include the prov- 
mgs of Jorg, Martin, Schneller, Schroff, Harley and 
Ringer m the old school, and of the Austrian So- 
ciety, of many later Germans, of a few French and 
English, and of perhaps a majority of the numerous 
American workers, m our own. On the other hand, 
Hahnemann's later domgs have given the impetus to 
much work which must be pronounced as thoroughly 
bad. Following his example, many symptom-lists 
have been published as belonging to medicines, with- 
out the least explanation of the manner in which 
they were obtained : the ArcJiiv, and Hartlaub and 
Trinks' Annaleu and ArzneiinittcllcJire, are full of 
them ; and Petroz in France and Hering here gave 
a number more. The observation of symptoms in 
the sick became quite common ; and these patients 
afforded yet another opportunity for supplying the 
Materia Medica with symptoms. Aggravations of 
their existing troubles occurred from time to time 
during treatment, and were of course ascribed to 
the energy of the medicines they were taking ; and 
these were, not without countenance from Hahne- 
mann, set down among the symptoms of the drug. 



"clinical symptoms." 281 

Roth quotes one such instance from the Chronic 
Diseases under Colocynth, and says that he has fre- 
quently found the same proceeding resorted to else- 
where. But the imitators of the master's weaknesses 
have quite outdone him as regards the utilisation of 
the sick for enriching the Symptomen Codex. When 
in a prover some existing deviation from health dus- 
appeared during the action of a drug, Hahnemann 
recorded it, adding " Heilwirkung " (curative effect). 
Only in the mstance of lodium has he done this with 
definite maladies (as goitre and enlarged glands) 
treated with the medicine. But his disciples have 
seized upon the proceeding and carried it to lengths 
from which he would have shrunk aghast. They 
have freely admitted '* clinical symptoms " (*' that 
abominable fallacy" as Dr. Allen justly terms it 
" which has poisoned the fountains of our Materia 
Medica from Hahnemann to the present time ") into 
our pathogenetic lists, cutting up the cases which 
have recovered under the action of a remedy into 
their component parts, and sowing these in the appro- 
priate plots of the schema. They at first (as in 
Jahr's "Manual") denoted such symptoms by a sign 
(° or *) ; but soon grew careless about affixing it, and 
at last (as m Lippe's " Text-book " and Hering's 
"Condensed Materia Medica" and "Guiding Symp- 
toms "; avowedly omitted it altogether. 

When, side by side with these proceedings, there 
went on an increase of attenuation up to unimagin- 
able limits, and a corresponding gobeutoiicherie of 
belief m the energy of these wonderful potencies, 



282 THE FUTURE OF PHARMACODYNAMICS. 

the evil grew ever greater. It culminated in two con- 
summate flowers. One was Wolf's ''proving" (!) of 
Thuja, where he took a single globule of Jenichen's 
1,000th potency (i.e. about Hahnemann's 40th),' and 
recorded every deviation which occurred in his health 
for the next two years (including an attack of small- 
pox) as the result of this violent dose. The other is 
Houat's Nonvclles Doiniees, where almost every ill 
to which flesh is heir is ascribed (among others) to 
those potent poisons, Robinia pseudo-acacia, Cubeba 
of^cmalis, and Piper nigrum.^ To such deliberate 
vitiations as I have now depicted are to be added 
those incidental to time and use — the hav^oc wrought 
by imperfect translation and re-translation, the errors 
of repeated copying, and such like. The result is 
(I do not hesitate to say it) that our Materia Medica 
is an Augean stable almost as foul as was the com- 
mon one when Hahnemann exposed its condition, 
and set himself to the Herculean task of its puri- 
fication. When we add thereto the unfortunate 
schematic arrangement on which I have already 
commented, its evil state becomes yet more appar- 
ent. It is, in great part, what some one caustically 
styled Jahr's Manual, " nonsense made difficult." 

What, then, is to be done ? First of all, we must 
winnow the many grains of wheat which are scat- 
tered through the mass of chaff which lies before 
us. In pietas to Hahnemann, his work should (as I 
have said) be translated as he has left it, with such 

^ See Brif.Journ. of Horn., Jan. 1881, art. *' Dilutions." 
2 /^/V/., vol. xxvii., 137, and xxxviii., 4. ■ 



THE MATERIA MEDICA OF THE FUTURE. 283 

editing as any similar books would receive. Eng- 
land has done this for the Materia Mcdica Pura, and 
she looks to America to do it for the Chronic Dis- 
eases. When we have these volumes as they should 
be presented, let them stand on their own merits. 
Let us leave the symptoms of Hahnemann and his 
associates, so far as they are only accessible there; 
and proceed to deal with the more manageable mate- 
rial which lies outside it. Let this be thoroughly 
sifted, — without scepticism, indeed, but without 
credulity ; and let what remains be presented in the 
most accurate, concise, and instructive form, — repe- 
titions being avoided, redundancies pruned, and all 
provings given, where possible, in consecutive order, 
as related by the experimenters. The student will 
then have the text of his medical bible, and will have 
it in genuine and intelligible form. Genuine, — 
because all versions and copies will be traced back 
to their tdtiviate original, and verified, corrected, or 
reproduced therefrom ; because all clmical symptoms 
and (supposed) medicinal aggravations will be ex- 
cluded, and phenomena observed in patients taking 
drugs accepted only on amply sufficient evidence ; 
because provings themselves will be rigidly scruti- 
nised, and not admitted — at least in any complete- 
ness or full-sized type — unless their source and 
method seem free from objection. And intelligible, 
because all observations and experiments will be 
related in detail, or in sufficient summary, so as to 
preserve the order of evolution of the drug-effects. 
We shall then have a series of individual pictures of 



284 THE FUTURE OF PHARMACODYNAMICS. 

the morbid conditions induced by our medicines, and 
— so far as they go — shall only have to fit them to 
idiopathic disease, on the immortal principle similia 
siinilib7is, to have the homoeopathic method at our 
full disposal 

But then will open before us another task, that 
of re-proving and fresh experiment. The very ex- 
hibition of our extant material will shew many a gap 
to be filled up, many a deficiency to be made good. 
And further, we ought to improve upon what we 
have. With our better knowledge of the natural 
history of health, and of the influence of expectant 
attention, to obviate self-deception ; with our in- 
creased command of modes and instruments of pre- 
cision ; with our enhanced acquaintance with the 
order we are to disturb and the disorder we desire 
to simulate, we ought to make provings greatly 
superior to those even of Watzke and his fellows. 
For the means of making them I would only say, Cir- 
citmspice. Dr. Dake ' calls for Pro vers' Colleges ; 
but in the Homoeopathic Schools of America you 
already have a dozen of such. Let the Materia 
Medica classes of these, under their respective Pro- 
fessors, prove each year a single drug ; and we shall 
soon have a body of experimentation of which we 
may be proud. 

This, however, is the work of to-morrow. That of 



* The work which this physician has done in exposing the deficiencies of 
our existing Materia Medica, and shewing the way to improvement, will always 
entitle his name to honour (see Transactions of Amer. Inst, of Homoeopathy 
for 1857, 1873, •^74> ^"<i o^ World's Hom. Convention of 1876). 



CONCLUSION. 285 

to-day is the garnering up of our existing wealth, 
and the making it immediately available. To this 
task, feeling its urgency, but knowing its magnitude, 
I have purposed (God willing) to devote the remainder 
of my literary life. I have obtained for it the assent 
and support of the British Homoeopathic Society ; 
and I have come over here as its delegate to seek the 
co-operation of the American Institute of Homoeopa- 
thy. The invitation which, on my way, has diverted 
my steps to Boston has brought me many gratifica- 
tions. But I shall be best rewarded for any trouble 
I have taken if I can secure for my proposals the 
advocacy of those who have listened to me here, — 
of students, and professors, and physicians in gen- 
eral. Believe me that you will thereby be helping 
forward a work which will give us quite a new aspect 
in the eyes of the profession at large; which will 
make acceptance of homoeopathy far readier, its 
study more easy, its practice more delightful and 
successful ; and so will redound to the advantage of 
that common humanity for which each man should 
live, and in losing his individual life for which he 
most surely finds it. 



i 



INDEX. 



Acidum carhoUaim in hyperosmia, 233. 
" lactictun in rheumatism, 141, 184. 
" imiriatiaim in fever, 135. 
" phosphor icuni in fever, 134. 
•' saiicy/icuvi, in rheumatism, 158; in Meniere's disease, 255. 

^<r^////<', indications for in inflammation, 81, 109; Hahnemann on, 104; 
Bartho.low on, 104; Ringer on, 105; febrigenic power of, 107; 
action in fevers, loS; in pneumonia, no; anti-rheumatic, 148; in 
rheumatism affecting heart, 150; in lumbago, 150; in neuralgia, 
242; action on cerebral cortex, 251. 

Acoiiitine, in neuralgia, 241. 

Agnricus, in fever, 122; in locomotor ataxy, 238. 

Air, need of pure, 31. 

Alcohol, 42. 

Alexander, provings by, 265. 

Alkalies in rheumatic fever, 142. 

Ambidexterity, 209. 

Amyotrophic paralyses, 223, 224. 

Angina pectoris, 78. 

Ankle-clonus, 222. 

Anstie, on neuralgia, 240. 

Antipathy, 79. 

Antipyretic treatment, loi. 

Aphasia, 197. 

Arsenic, as antipyretic, 124; in pernicious ansemia, 125; as anti- 
rheumatic, 183; in locomotor ataxy, 239; in neuralgia, 243. 

Atropia, action of, 252. 

Attention, power and seat of, 210. 

Baptisia, in fever, 136. 

Eartholow, on Aconite, 104. 

Bath, the cold, 29. 

Eeale, researches on protoplasm by, 13. 

Eell, Sir C, discovery of, 188. 

2Z7 



288 INDEX. 



Belladonna, time of occurrence of symptoms of, 8i ; action on pupil, 
115; febrigenic power, u6; place in fevers, 118; in scarlatina, 
119; in variola, 120; action on visual centres, 230; in locomotor 
ataxy, 240; ni neuralgia, 242; action on cerebral cortex, 252. 

Blake, E., on sewer-gas, 31. 

BoLLE, on Rhus, [67. 

Broca, on seat of speech, 199. 

Brovvn-Sequard, on sensory paths in cord, 192. 

Brunton, Lauder, on amyl nitrite in angina pectoris, 79; on action 
of Atropia on heart, 263. 

Bryonia, aggravation of symptoms by motion, 81 ; in fevers, 131 ; in 
rheumatism, 144. 

Burt, Physiological Materia Medica, 84; proving of Caulophyllum, 
174. 

Calcarea, in deficient calorifaction, 30. 

Camphor, relation to cholera, [27. 

Cannabis Indica, in general paralysis of insane, 252. 

Caidophvllum, in rheumatism, 174. 

Ceanotkus, action on spleen, 62. 

Cerebellum, function of, 189. 

Cerebral localisation and trephining, 225. 

Cerebro-spinal tract, 215, 

Cerebrum, sole seat of consciousness, 194, convolutions of, 196; 

electrisation of, 200; cortical sensory and motor centres in, 203; 

frontal lobes of, 210; arteries of, 213; histology of, 217; results 

of softening in, 218. 
Chaffee, proving of Propylamine, 157. 
Chamomilla, hyperassthesia of, 81, 243, 255, 
Characteristics, 80. 
Charcot, 213, &c. 

China, as antipyretic, T27; in neuralgia, 243. 
Chininum arsenicosum, in pyaemia and septicaemia, 129. 
"Chronic Diseases," the, 273. 
Cimicifnga, in rheumatism, [73. 
Clariv, Sir Andrew, on clinical medicine, 66. 
Claude, on rhythm of medicines, 81. 
Climate, T^y 

Clinical medicine, 66, 69. 
Clinical symptoms, 281. 
Cocculns, in migraine, 254. 
Cocoa, 40. 

Coffee, as beverage, 40; as medicine, 81, 255. 
Colchicum, characteristic symptom of, 8r ; in rheumatism, 151. 
Colocynth, in neuralgia, 243. 

Columns of Burdach, 237; of GoU, 237; of Turck, 215. 
Conium, action on eyes, 254. 
Crotalus, as antipyretic, 129. 
Cuprum, in amyotrophic paralysis, 225 (note). 
Cyclamen, in migraine, 249. 



INDEX. 



Dake, on the Materia Medica, 284 (and note). 

Descending scierosis, 216, 219. 

Diagnosis, 51. 

Digitalis^ action on heart, 75; in migraine, 247. 

Discharging lesions, 227. 

Drug-experiments on animals, 261. 

Drysdale, on protoplasmic doctrine of life, 14; definition of specific 

action, 53; on Kali bichromicum, 182. 
Dnlratnara, in rheumatism, 168 
.Dunham, Carroll, on hygiene, 23; on totality of symptoms, 54; on 

Aconite in inflammations, 109; on Rhus in fevers, 134; on Kalmia 

in endocarditis, 172. 
Dyce Brown, on agaricus in locomotor ataxy, 239. 

Empiricism, 70. 

Epilepsy followed l)y paralysis, 231. 
Epile]5tic aura, 231, 250. 
Exercise, 25. 

Ferrter, on the cerebellnm, 190; on the cerebrum, 2or. 

Fever, nature of, 57, 92; kinds of, 58, 98; catarrhal, 94, 113; cerebro- 

sj^inal, 123, 130, gastric, 99, 132, 136; hectic, 97, 124, 128, 137; 

inflanmiatory, 108; intermittent, 97, 124, 127; relapsing, 49, 132; 

remittent, 1(3; rheumatic, 140, 145, 148, [51, 154, 156, 165, 169, 

176; typhoid, 119, 125, 132, 134, 135; typhus, 119, 121, 122, 125; 

yellow, 130. 
Fletcher, doctrine of life, 12. 
Flourens, on function of cerebellum, 189. 
Food, 34. 

*' Fragmenta de Viribus," the, [65. 
FRirscH and Hitzig, experiments on brain, 200. 

Gall, on the brain, 188, 196. 
Gi'lseniiiini, as antipyretic, 112, 
GowERS, case by, 228. 
Graves, on Belladonna, 115. 

Hahnemann, doctrine of life, 16, 20; a hygienist, 22; chooses symp- 
toms for disease-basis of his method, 46; scientific value of his 
"totality of symptoms," 55; relation to pathology, 60; definition 
of medicines, 69; founder of experimental pharmacology, 71; 
characteristics by, 81; on Aconite, 103; on Bryonia, 131 ; on 
Rhus, 133, 164; on Ledum, 175; on Materia Medica of his day, 
259; contributions to Materia Medica Pura, 269; citations from 
authors, 271 ; contributions to Chronic Diseases, 274. 

Haller, on need of drug-provings, 265. 

Hamilton, on physiological oscillations, 267. 

Harley, on Belladonna, 116; on Hyoscyamus, 121. 

Mayward, on Crotalus, 129, T30. 

Hem pel, "Materia Medica," 84. 



290 INDEX. 

Henderson, Prof., on pneumonia, iii. 

Hepar, sensitiveness of patient, 81. 

Hering, on Kalmia, 171 ; Arsenic symptoms by, 278. 

Homoeopathy, provings of, 72; Materia Medica of, 83, 280. 

HouAT, provings of, 282. 

HuBER, on Mercury, 177, 179. 

Hydrocotyle, in trigeminal hypersesthesia, 243. 

Hygiene, 25. 

Hyoscyamus, as antipyretic, 120; in neuralgia, 243. 

Hyperpyrexia, 96, 138, 140. 

Ic^natia, in migraine, 245. 

Imbert-Gourbeyre, on Arsenic, 183. 

Inflammation, 58. 

J odium, 255. 

Iris, neuralgia of, 243 ; in migraine, 250. 

Jackson, Hughlings, on cerebral pathology, 226. 
Jousset, on life, 17; on Digitalis, 75; on Phosphoric acid, 135; cun 
of anterior poliomyelitis by Plumbum, 224. 

Kali hichrouiictim, in rheumatism, 182. 
Kalmia, in rheumatism, 171. 
Kitchen, on Viola odorata, 176. 

Lachesis, characteristic of, 81; in Fevers, 129. 

Late rigidity, 221. 

Ledum, in coldness, 29; in rheumatism, 175. 

Life, 7. 

Liv'EiNG, on migraine, 243. 

Locomotor ataxy, 236. 

LuDLAM, on Veratrum viride, 123; on Caulophyllum, 174. 

LycopodiMH, characteristic of, 81. 

Marshall Hall, 188. 

" Materia Medica Pura," the, 268. 

Medicine an art, 50. 

Medicines, definition of, 69. 

Merniriiis, in rheumatism, 176; action on cerebrum, 255. 

Migraine, 243. 

Mitchell, on Baptisia, 137. 

MoLiN, proving of Tartar emetic, 86. 

Natrttm vitiriatiaim, in deficient calorifaction, 30. 

Neuralgia, 240. 

Neuroses, the, 59. 

Nitrite uf amyl, in angina pectoris, 79. 

Nosology, 48. 

Nux 77ioschata, 253. 

Nux vomica, in hemiplegia, 224 ; in neuralgia, 243 ; in migraine, 246. 



INDEX, 291 

Organopathy, 61 • 
Overdosing, 264. 

Paralysis, general, of insane, 252, 253. 

Pathology, 60. 

Fetroz, on Dulcamara, 168. 

" Pharmacodynamics, Manual of," 84. 

Phillips, "Materia Medica," 162; on Arsenic in chronic rheumatism, 

184. 
Phrenology, 195. 
Fhytolaccn, in rheumatism, 183. 
Flafi/ia, in neuralgia, 243. 
Fluml'Ht/i^ in amyotrophic paralyses, 224. 
Pneumonia, treatment of, no. 
Poisoning, 263. 

Pope, on pathogeneses of Chronic Diseases, 279. 
Potter, proving of Aconite, 249. 
Pricp:. ])roving of Bryonia, 145. 
Fropylaminc, in rheumatism, 155. 
Protoplasm, 11. 
Proving, 265, 266. 

Fnlsatilla, characteristics of, 81 ; in rheumatism, 139. 
Pyaemia, 99, 129. 

Quinine, in malarious fevers, 127 ; in Meniere's disease, 255. 

Re-proving, 284. 

Rest, 26. 

Reynolds, Russell, on subjective symptoms, 63. 

Rheumatism, 139. 

RJiododeiidroji, characteristic of, 81 ; in rheumatism, 170. 

RJuts, characteristics of, 81 ; in fever, 183; in rheumatism, 162. 

Ringer, on Aconite, 105; on Arsenic, 125. 

Roth, on Agaricus, 122. 

Ruta, in rheumatism, 175. 



Santonine, cerebral action, 256. 

Scarlatina, 119, 130. 

ScHROFP', on Aconitine, 241. 

Septicaemia, 99, 129. 

Sewer-gas, 31. 

Sircar, on pathogeneses of Chronic Diseases, 278. 

Speech, seat of, 199; acquirement of, 207. 

Sfig-elia, in rheumatism, 172; in neuralgia, 243. 

Stramoniuvi, in fever, T2I ; in neuralgia, 243. 

Stiychnia, in hemiplegia, 224, 236. 

Subjective symptoms, 62. 

Siilphtir, characteristics of, 82; in rheumatism, 185. 

Symptomatology, 54. 



292 INDEX. 

Tartar emetic, proving of, 86. 

Tea, 40. 

Tendon-reflexes, 223. 

Tessier, doctrine of life, 16; definition of maladies, 52; on Viola 

odorata, 176. 
Teste, on Aconite, 109; on Colchicum, 153. ^ 

Tobacco, 4T. 

Todd, on the cerebellum, 189; on late rigidity, 221. 
Trophic centres of nerve fibres, 220. 

Variola, 120. 

Vegetarianism, 37, 

Veratrum viride, as antipyretic, 123. 

Viola odorata, in rheumatism, 175, 

Vital .force, 16. 

Volition, process of, 207. 

Warmth, 28. 

Water, 39. 

Wesselhoeft, C, 2T, 267. 

Wolf, proving of Thuja, 282. 

WuRMB and Caspar, on Phosphoric acid, 134. 



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